Introduction Treatment Escalation Plan forms (TEPs) are used to formally document the ceiling of care for all patients and to provide a clear plan should they deteriorate. This is especially important for patients near the end of life out of hours.

Aims

• Assess level of TEP implementation on a general medical ward in QEQM Hospital, Margate

• Identify barriers to implementing TEPs

• Discover ways to increase TEP implementation

Method We collected multiple data cycles of 50 patients each and recorded the proportion of patients with a TEP in their paper notes. Various interventions were implemented between cycles to optimise timely TEP completion. We surveyed clinician’s views on TEPs.

Results Initially 24% of patients had a TEP. Post cycle interventions, including ward meeting discussions and posters showed no significant increase in implementation. Clinical staff value TEP forms, but barriers to completion include constraints relating to workload and senior authorisation.

Conclusion TEPs are valuable to formally document appropriate care, especially for patients nearing the end of life out of hours. However, we found baseline implementation sub-optimal and did not improve significantly following intervention despite perceived importance by clinicians.

Impact Our work indicates medical staff value formal documentation of treatment plans in a standardised manner for patients near the end of life, and feel they improve out of hours care. However, it is likely that more targeted initiatives are needed to remove barriers relating to timely implementation of this documentation.