Background The “Five Priorities for Care” (5 PFC) at the end of life were established after the Liverpool Care Pathway (LCP) was phased out. In order to meet these priorities, London North West Healthcare created the “Last Days of Life Care Agreement” (LDLCA); a template for end of life discussions.
A 2016 audit of the use of the LDLCA within Northwick Park Hospital showed that it was not being adequately filled out. There was poor documentation surrounding end of life symptom assessment, ongoing discussions with family members and acknowledgement of spiritual needs.
As a result, the LDLCA was re-written and structured around the 5 PFC. A “symptom chart” from another trust1 was introduced to record the severity of end of life symptoms. The new LDLCA was trialled on four wards and its impact on end of life care was re-audited.
Methods All patients on the new LDLCA were reviewed over an 11 week period from 9th August 2016 (n=18). Notes were assessed for evidence of the 5 PFC being achieved and frequency of end of life symptom assessment.
Results All 5 PFC were achieved in 100% of patients. An end of life discussion was had with 100% of relatives prior to commencing the LDLCA. Ongoing discussions with families were documented in 61% cases (previously 16%). Assessment of spiritual needs was done in 67% (previously 27%). There was evidence of symptom assessment in 100% of patients however these were only recorded on a four-hourly basis in 56%.
Conclusions A written care agreement can create a care plan focussed on the 5 PFC. Creating this from a discussion produces individualised care and reduces the risk of “tick-box” care seen with the LCP. A specialised “symptom chart” can aid assessment of end-of-life symptoms and help achieve the care plan.
1. Mason LD. Brighton & Sussex University Hospitals NHS Trust.
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