Retrospective analysis of case notes to review the unexpected deaths on a specialist palliative care unit. Our aim was to review and analyse patient notes from our inpatient specialist palliative care unit where death had not been recognised by the treating team.
We analysed twenty sets of case notes from March 2020 to March 2021. The following questions were answered; length of admission, documentation about expectation of death and discussion with the patient and relatives about this, last recorded phase of illness and functional status in MDT discussions and if active treatment was being given at the time of death. A thematic analysis was undertaken of these results and several trends were evident. We found that patients with a shorter admission and younger patients who have been resistant to advance care planning discussions were less likely to be identified for the end-of-life record of care.
From this research we have identified the need for more open discussions around expectations of death, we have increased the number of professionals undertaking advance care planning courses including doctors and nurses on the inpatient unit. We acknowledge that deaths cannot always be expected, however, we would like to implement more robust advance care planning discussions, proactive management and maximum exposure to MDT management for all patients.
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