Introduction We completed an audit to review end of life care for adult patients who died on intensive care (ICU) at the Royal Victoria Infirmary, Newcastle upon Tyne. The audit aimed to benchmark against NICE guidelines: Care of dying adults in the last days of life (NG 31).
Methods Case notes from all expected deaths on adult ICU during April and May 2021 were reviewed retrospectively by four reviewers. The reviewers included a collaboration of palliative and critical care doctors. Data was collected on recognition of dying, communication with the patient and their family and individualised care.
Results There were 16 expected deaths. 100% of patients were recognised to be dying. The median time from recognition to death was 46 hours. In all cases there was discussion, with family, about the patient being unwell enough to die. 94% included discussion about patient wishes at the end of life. These discussions were had with the patient in only 25% of cases – in the majority, the patient was too unwell for these discussions. Reviewers agreed that daily symptom and hydration assessment was applicable for 9/16 patients, with 100% achieving these indicators. 7/16 were felt not applicable for this aspect of the review, due to brain stem death (3/16) or short time to death (hours) after withdrawal of life sustaining treatment (4/16). 92% of patients had anticipatory medications prescribed, with indications. Only 31% of cases had documented assessment of whether there was a pre-existing advance care plan (including advance statement, lasting power of attorney or emergency healthcare plan).
Conclusion The audit demonstrated good individualised care of dying patients, with examples of excellent communication and individualised care. An area for improvement is to include assessment of pre-existing advance care planning within ICU admission documentation.
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