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47 Can staff education improve utilisation of the ‘All Wales Guidance: Care Decisions for the Last Days of Life’ for people approaching the end of life residing in nursing homes? – A Quality Improvement Project
  1. Catriona Seed,
  2. James Davies,
  3. Terri Gazi,
  4. Fiona Rawlinson and
  5. Mirella Longo
  1. City Hospice; Cardiff University


Aims Recognition of when a person is approaching the last hours/days of life can be challenging for healthcare professionals with a search of the literature demonstrating that the dying phase is poorly recognised across different clinical and home settings. The provision of end-of-life-care for people approaching the last hours/days of life in Wales is supported by the All Wales Guidance: Care Decisions for the Last Days of Life (CDLDoL), however there is poor utilisation of this guidance in nursing homes (NH). A quality improvement project (QIP) was designed to evaluate if education on recognising the dying person and the CDLDoL would improve the utilisation of the guidance with the aim of improving the provision of end-of-life-care in NHs in the Cardiff area.

Methods Three NHs were recruited and ten teaching sessions across the three NHs were conducted. Data on all deaths was compared for a 6-month period pre- and post-intervention.

Results Before the teaching intervention, there were no residents (0%) that had their care guided by the CDLDoL. Following the teaching intervention, both qualified and non-qualified staff stated improved confidence in recognising when a person is approaching the end of life and providing end-of-life-care. 2 residents (6.5%) had their care guided by the CDLDoL and the percentage of residents with end-of-life medications prescribed at time of death increased from 56.5% – 76.2%.

Conclusion The QIP demonstrated that the teaching had a positive impact on the confidence levels of NH staff with improved provision of end-of-life-care. Further clinical research within the wider palliative care community on the dying phase should be conducted as well as further research into the perceived barriers and challenges of using the CDLDoL. The QIP will be extended across other NHs across Cardiff, as well as extending the teaching to GPs and community nurses.

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