The National Institute for Health and Clinical Excellence published the ‘Quality Standard for End of Life Care for Adults’ in 2011 (updated 2013).

Four of the standards make specific reference to provision of a care across the 24/7 period.

Currently all patients under the community palliative care service, their families and any professionals supporting them can access out-of-hours (OOH) specialist palliative care support from a clinical nurse specialist (CNS) via the telephone. It is widely considered that the optimal service provision would include access to face to face visits 24/7.

In order to understand the scope of local need for access to a 24/7 visiting service, a review of all OOH calls received over a one-month period was undertaken.

A retrospective review was undertaken examining the clinical records relating to 34 OOH calls in an attempt to understand whether an OOH face to face visit by a CNS would have led to a more favourable patient outcome.

The reviewers felt that on the following four occasions, face to face assessment carried out by a CNS may have led to a more favourable patient outcome:

1. No contact was made with the OOH CNS. Patient was transferred to hospital with no assessed clinical need.

2. Patient had multiple symptoms which made telephone assessment difficult.

3. Patient suffering from breathing difficulties with known social complexities

4. Patient had no recent CNS input and had uncontrolled symptoms.

Next steps include Increased promotion of the OOH CNS service and when and how to access it.

Provision of written guidance for patients and carers about the potential for changes in the patient’s condition and instruction on how to proactively manage symptoms to avoid crises.