Background Morbidity and Mortality Meetings (MMMs) are an opportunity to review patient cases by reflecting on practice, identifying learning points, enhancing quality of care and ultimately improving patient safety (Sinitsky, Gowda, Dawas, et al. Patient Saf Surg. 2019; 13:27; Healthcare Improvement Scotland. Morbidity and mortality reviews: practice guide – working version. 2018). Some hospital palliative care teams have implemented the use of MMMs to improve end of life care (Lockwood, Pal, Strutinsky-Mason. BMJ Support Palliat Care. 2020; 10(S.1): A56–A56), however, there is limited evidence on hospice MMMs and related staff experiences.
Aims To evaluate hospice staff experience of MMMs and to assess the benefit of regular case based reflective forums.
Methods Criteria was set for case inclusion by the medical team. Retrospective data was collected monthly on all hospice inpatient unit deaths from December 2022, including patient initials, date of death and life-limiting diagnosis. Monthly MMMs were held and included selected anonymised patients from a one month time period. An overview of each patient was presented with PAcE model (patient, activity and environment) case analysis, relevant literature review and clinical practice recommendations. Action points were identified at each meeting. Multimodal feedback was then collected.
Results To date, four MMMs have been held. They have been attended by doctors, community and inpatient nurses, nurse managers and wellbeing support workers. Six participants provided online feedback and three participants provided verbal feedback. Preliminary results indicated staff found it beneficial to reflect on previous cases and to discuss decision making rationale. It was highlighted that nursing staff involvement and representation could be improved. Five respondents stated that MMMs have helped to identify a personal learning need, improve individual clinical practice and improve patient care. All respondents stated they would attend future MMMs.
Conclusion Further data will be collected, however, hospice MMMs play an integral part in reflective practice and improving patient care whilst also identifying learning needs and improving clinical practice. Further directions: we will continue MMMs and include community patients in the case mix.
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