Background The Respite and Response team at Ayrshire Hospice supports people to be cared for and die at home, if that is their choice. The team also aims to prevent unnecessary hospital admissions, and provides respite for carers. During 2021/22, 167 people were supported by the team to achieve their preferred place of death at home. Short-term goals are discussed at every visit (when appropriate), with the team aiming to help the patient realise their goal, or facilitate an adapted version wherever possible.

Aim Documentation in the patient record did not accurately reflect the person-centred care carried out. An initiative was launched by a team member to improve practice – specifically regarding documentation of patients’ goals. The aim being that 95% of Respite and Response patients will have up-to-date person-centred goals documented by June 2023.

Methods The project lead presented to colleagues on the importance of discussing and documenting goals (Boa, Wyke, Duncan et al. BMJ Support Palliat Care. 2012;2:A9-A10) during a team development day. The team also linked with a local representative from The Care Inspectorate, responsible for regulating the service. A baseline audit was completed, looking at the level of personalisation and frequency with which goal setting was recorded. A run chart was displayed within the team office, with percentage compliance plotted at fortnightly intervals.

Results The project is ongoing at the time of writing, however, initial results are positive, with an increase in individualised goals being documented at each visit from 65% to 90% in the first month of the project. This will continue to be monitored to ensure practice is embedded.

Conclusion This project, being driven by a team member passionate about goal-setting with patients, coupled with explaining why the practice is important from the perspective of the regulator, have helped to achieve buy-in from the team.