Background Maintaining hydration at the end of life can be emotive and controversial. Practice varies widely regarding use of clinically assisted hydration (CAH) and there is lack of evidence-based guidance. Communication and documentation surrounding CAH and mouth care is essential. Practice on a Palliative Care Unit was assessed, comparing to results from 2017 and 2018.
Methods Retrospective review of medical notes for deaths between 1st October-31st December 2019. A data collection tool utilised during previous audit cycles was used to ensure comparable results. Patients not identified in the dying phase and sudden deaths were excluded.
Results A reduction in documented discussions about hydration, the risks/benefits of this (44% vs 60% 2017, 73% 2018) and mouth care (32% vs 35% 2017, 61% 2018) with patients and/or those important to them were identified. Where prescribed fluids were not completely delivered, reasons for this in previous years were documented in 100% of cases, reducing to just 80% in 2019. There was a decrease in documented reasons for stopping fluids prior to death (90% vs 80% 2017, 100% 2018) and discussion of this with the patient and/or those important to them (20% vs 50% 2017, 20% 2018). Fluids were most commonly prescribed for thirst and dry mouth, and stopped due to chest secretions and pooling.
Conclusion Introduction of a consultant ward round sticker prompting individualised hydration and mouth care plans following cycle 1 (2017) initially resulted in an improvement of discussions about hydration and mouth care, and documented reasons for any changes. Whilst the stickers provide evidence that hydration and mouth care are always considered, there is a decrease in documented discussions surrounding this. This is possibly due to lack of documentation, rather than a failure to discuss and may have been contributed to by a change in personnel, highlighting a need for education.
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