Introduction End-of-life (EOL) care following a withdrawal of life-sustaining treatment occurs commonly in an intensive care unit (ICU) (1,2). Following the discontinuation of the Liverpool Care Pathway in 2014, local guidelines have been developed and tailored to the University Hospitals Bristol and Weston NHS Foundation Trust ICU, United Kingdom. This quality improvement project (QIP) aims to assess awareness and improve compliance with the guideline.

Method A clinical audit and staff survey were undertaken to establish current compliance with local guidelines. Findings were presented to stakeholders for evaluation, followed by two Plan, Do, Study, Act cycles. A set of educational, barrier-reducing and sustainability-ensuring interventions were implemented following Kotter’s model for change management (3).

Results The baseline data analysis revealed that The EOL Care Tool, a Trust-wide available checklist outlining the appropriate approach to EOL care delivery, was used in 14% of cases over five months. The initial clinical staff survey demonstrated that this was due to the lack of awareness and uncertainty about the applicability of a Trust-wide tool in the ICU. Following the implementation of educational and barrier-reducing interventions, compliance with the EOL Care Tool slightly increased to 29%. However, a change in the daily safety brief resulted in 73% compliance with the EOL Care Tool while significantly improving the delivery of EOL care, such as EOL prescribing, stopping interventions and switching from vital sign monitoring to symptom observations. Furthermore, qualitative feedback from clinical staff following the second PDSA cycle revealed increased occupational satisfaction with the departmental provision of EOL care and improved interprofessional cooperation within the unit.

Conclusion This QIP optimised patient-centred EOL care with adequate symptom control in the local ICU by raising awareness of available resources and encouraging compliance with relevant guidelines. Subsequently, the interprofessional collaboration resulted in a positive culture change in the local unit.

References

1. (ICNARC) ICNARC. Report 1. Deaths in adult, general critical care units in England and Wales 1 January 2007 to 31 December 2009 [Available from: https://www.icnarc.org/Our-Audit/Audits/Cmp/Our-National-Analyses/Mortality.

2. Wunsch H, Harrison DA, Harvey S, Rowan K. End-of-life decisions: a cohort study of the withdrawal of all active treatment in intensive care units in the United Kingdom. Intensive Care Medicine. 2005;31(6):823–31.

3. Barrow JM, Annamaraju P, Toney-Butler TJ. Change Management. [Updated 2021 Oct 9]. In: StatPearls. Treasure Island (FL): StatPearls Publishing