In 2010 a baseline audit was conducted to establish what proportion of Day Hospice patients were aware of, had discussed or had completed a Preferred Priorities for Care document (PPC). The audit was done in preparation for piloting the PPC, as a tool for advance care planning. The aim of the audit and piloting of the document was that all Day Hospice patients within the last 12 months of life (GSF) would have been offered a PPC document as part of their advance care planning. This was in support of the recommendations from the End of Life Care Strategy 2008.
The methodology used was a retrospective audit of the patient notes documentation and Day Hospice patient interviews to identify relevant information with regard to advance care planning. The audit was repeated 3 months later.
The audits clearly demonstrated that Day Hospice does provide an excellent opportunity to discuss and give information about advance care planning. However, the audit demonstrates that most patients appear to prefer to complete a PPC document at home with assistance from either a family member or Healthcare professional. It also identified that staff needed to have an increased familiarity with the document and in initiating the conversations.
Practice change resulting from the audit relate to a need to continue to raising staff and patient awareness every 3 months and to develop a patient information leaflet outlining choices for advance care planning, which is to be inserted in all new patient notes to promote discussion.
All these changes have now been implemented. Empirical evidence suggests that the audit process has been highly successful in facilitating change through team involvement. A repeat audit will be conducted to provide hard evidence of that success.
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