Background Recognition of dying is an integral part of best practice in end of life care. The Dying Phase (DP) is included in the Outcome Assessment and Complexity Collaborative (OACC) suite of measures. Individualised care plans for dying patients have been a key initiative since the demise of the Liverpool Care Pathway. At our hospice Phase of Illness has been captured on our electronic patient record (Crosscare) for two years and a new care plan for the dying window introduced in November 2016. The care plan was created to be used across clinical settings with a printable option for patients cared for in the community.
Aim To review patient records in a 15-bedded hospice inpatient unit and evaluate if DP was recognised in a timely manner and appropriate care plan commenced.
Method All patients who died or were identified as dying in the two months following the initiation of the new care plan were included. Notes were retrospectively reviewed including dates DP was recorded and care plan created. An Excel toolkit was used to analyse the quantitative data. A separate quality review of care plans was conducted by a senior nurse.
Results 37 patients were included in the audit. 32 had DP completed, of these two did not have individualised care plans completed as they died quickly. Only 29 had OACC phase updated. Mean length of time in DP was three days (range <1 day to 8 days). Quality of care planning was generally good and used as feedback for training.
Conclusion Incorporating Phase of Illness and individualised care plans for the dying person is important in the hospice setting with electronic records. This audit informed amendments to improve practice including retrospective entry of care plan if patient dies quickly and embedding Phase of Illness update into the care plan window.
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