Introduction This audit and service review looks at a collaborative approach to improving the end of life care for people with dementia on inpatient wards in Cornwall. It has prevented many inpatients resident on the inpatient dementia ward being transferred to the acute hospital for symptom control or terminal care.

Background People with dementia over 65 years of age are using up to one quarter of hospital beds at any one time and it is estimated that that the majority of the 100,000 people who die with dementia are in hospital. Multiple initiatives have set out to improve the end of life care of these patients. Despite this, there is evidence that suggests that end of life care for people with dementia is significantly poorer than for people without dementia.

Methods An inreach service to the dementia wards was provided by the hospice nursing and medical staff. The three key aspects were:

• Guidance - specific end of life care guidelines were written collaboratively, taking into account the complexities of setting, staffing and patient group.

• Confidence buliding - Dementia unit staff were educated in palliative care principles & skills, with hospice nursing staff & doctors providing peer education and support.

• Support - the dementia units were given 24/7 access to the hospice advice line with availability of consultant review withing 24 hours when needed.

Results Transfers of patients to the acute trust were reduced and end of life transfers eliminated in patients with contact with the inreach service. Staff confidence and expertise was developed to a high standard. Options for extending the service to nursing home settings are being explored.