Objectives To audit end of life care (EOLC) delivered by the Acute Surgical Unit (ASU) and Trauma team at Kings College Hospital against local guidelines, and to identify methods to improve quality of care.
Methods Retrospective analysis of electronic notes of all patients who died under the care of ASU/Trauma between August and November 2018. Patients who had isolated neurosurgical injuries, were transferred to another team more than 24 hours before death, or who died unexpectedly were excluded. Data concerning the five priorities of care for the dying person were extracted using a standardised tool. Interventions carried out after cycle one included junior doctor refreshers, EOLC lanyard prompts and posters in the doctors’ office, with repeat data sampling from April to July 2019 inclusive.
Results 12 patients satisfied inclusion criteria in cycle one and 6 in cycle two. Data demonstrated improvements in a number of areas. These included involvement of the palliative care team increasing from 50% to 83%, documentation of plans for hydration from 42% to 67% and nutrition from 50% to 67%, rationalisation of medication from 42% to 83% and of interventions from 33% to 83%. Improvement was seen in documentation of communication with patients and their family such as those relating to prognosis from 75% to 100%, CPR decisions from 50% to 83%, preferred place of death from 25% to 83%, assessment of Psychosocial or spiritual needs of the patient from 50% to 83% and for their families from 33% to 83%. However, the percentage of patients with CPR decisions remained 83% in both cycles.
Conclusions Use of simple educational interventions and prompts have demonstrated improved documentation of individualised end of life care plans in ASU/Trauma. Ongoing audit and continued education may lead to sustainable improvement in the quality of EOLC delivered by these teams.
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