Background The Universal Care Plan (UCP) allows London patients to have advance care planning shared between community and secondary healthcare (NHS South West London. Universal Care Plan for London [internet]). Universal Care Plans are editable by healthcare professionals, with online training available but not mandatory. UCPs improve end-of-life outcomes (patients with recorded treatment preferences are more likely to achieve their preferred place of death (Orlovic, Callender, Riley, et al. PLoS One. 2020 Dec 9;15(12):e0242914; Panozzo, Harvey, Adams, et al. BMC Palliat Care. 2020 Jul 14;19(1):108)) and prevents unnecessary repeated discussions; minimising patient distress and streamlining administration costs.

Aim To conduct a quality improvement project which a) measures current performance of a London hospice team in completing UCPs for patients during inpatient admission and b) designs effective interventions to improve performance.

Methods Retrospective analysis of discharge documentation on a three-monthly basis. Cycle 1 results were presented at a local audit meeting to raise awareness. Anonymous staff feedback survey conducted alongside Cycle 2 to identify barriers to UCP completion.

Results Cycle 2: n= 15. 66% had a Universal Care Plan on admission(n=10). 50% not updated on discharge despite changes to care plan (n=5). Universal Care Plans completed on discharge for only 60% of patients admitted without one (n=3). Eight staff members (3 nurses, 5 doctors) completed a concurrent survey. All agreed with the value of Universal Care Plans for patient care. Only 4 felt adequately trained to discuss UCPs and 2 (both doctors) felt able to complete UCPs. Qualitative responses revealed themes of time constraints, lack of training opportunities and access to the online UCP portal.

Conclusion Results indicate that we could further improve our performance regarding UCPs for hospice inpatients. Raising awareness had nil discernible benefit. Importance of UCPs is well-understood but time constraints and training inhibit completion in practice. Nurses are more likely to experience training barriers; a finding in-keeping with wider literature (Wilkin, Fang, Sixsmith. BMC Geriatr. 2024 Mar 28;24(1):294). At the Hospice UK conference we will present the results discussed thus far and a third cycle of audit data to evaluate the efficacy of a training-based intervention on UCP completion.