Background Everyone approaching the end of life should be offered the chance to create a personalised care plan.1
Hospice admissions are opportunities to forward plan, exploring preferences of care, resuscitation and emergency health care plans (EHCPs). Clear documentation and communication between teams can prevent distress and loss of dignity from unwanted or inappropriate treatments, and empower patients by respecting their wishes, especially where capacity is lost. This quality improvement project in St Cuthbert’s Hospice in Durham aimed to improve advance care planning including resuscitation and EHCPs, and communicating important patient preferences to the wider community team (Macmillan Specialist Nurses, General Practice).
Method(s) Baseline data was collected from current inpatient e-records on SystemOne and handheld notes from community or hospital settings, including:
• Resuscitation discussion on admission
• Confirmation of a paper ‘Do Not Resuscitate’ order
• Escalation planning (preferences for hospital transfer, and place of care at the end of life)
• EHCP documentation
• Utilising SystemOne ‘Alerts’
A ‘Friday Safety Huddle’ confirming clear escalation plans, and a multi-disciplinary team (MDT) meeting checklist identifying if an EHCP was appropriate in discharge planning, were initiated. Data was repeated at fortnightly intervals to reflect the average length of patient stay, over eight weeks (n=37).
Results Baseline data (n=9):
• 78% of patients had resuscitation discussions on admission
• 67% had a ‘do not resuscitate’ order
• 22% of patients had SystemOne ‘Alerts’
The introduction of Friday Safety Huddles and MDT checklist prompted appropriate discussions on resuscitation in deteriorating patients, EHCP completion, and improved resuscitation documentation to 100%.
Conclusion(s) Hospice multidisciplinary team input provides excellent opportunity to identify specific EHCP requirements. Communicating patient preferences to the wider community team is essential for continuity. SystemOne ‘Alerts’ supplement EHCPs in providing easily accessible handover of patient preferences (resuscitation status, hospital transfer, and care in the end of life).
National Palliative and End of Life Care Partnership (2021). Ambitions for Palliative and End of Life Care: A national framework for local action 2021–2026.
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