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51 To comfort always: introducing a novel method of recording appropriate physiological observations for patients at the end of life in a university teaching hospital in england
  1. Oliver Emmerson and
  2. Jon Tomas
  1. University Hospitals Birmingham NHS Foundation Trust, University of Birmingham


Introduction Collection of vital signs is a deeply ingrained part of hospital care and culture. Routine measurements in dying patients, however, are often superfluous and can be uncomfortable. QEHB patients in their last hours-to-days of life can be assigned to ‘Comfort Observations’ (CO) electronically. When initiated, an icon is displayed on the Trust’s observations recording system, suggesting only nominal observations be taken.

Objective To assess the feasibility of using electronic CO as a component of End of Life Care (EoLC) for acute hospital inpatients.

Methods The records of QEHB medical/oncology/haematology patients who died between 1/6/2017 and 31/08/2017 were accessed and the following data recorded: demographics; dates of: admission, CO initiation, death; evaluation of observations taken; prescribed medications. Numerical data was tabulated and analysed in Microsoft Excel.

Results 260 patients from the specified specialties died in the three-month period. 127 (49%) had CO initiated at the time of death, of which 74 (58%) experienced an inappropriate level of observation measurement. Mean length of admission: 11.20 days (1–69). Mean time between CO initiation and death: 2.86 (0–33) days. 30 patients (24%) were receiving intravenous antibiotics at the time of death.

Discussion Not all deaths were anticipated or of a nature such that CO should have been instituted. Nonetheless, when used, the mean time between starting CO and death suggests appropriate initiation. In contrast, only a minority of patients on CO had them done in accordance with Trust guidance. It is further concerning that a sizeable proportion of patients expected to die were receiving intravenous antibiotics.

Conclusion Our electronic CO system is a novel and viable method of initiating and recording observations for inpatients at the end of life. Despite this demonstrated reduction in personal burden it still remains to be seen what the effect of CO is on overall quality of EoLC.

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