Local CQC inspection of one acute NHS Trust (2015), highlighted that improvement in recognising dying and individualised care planning for the dying person was required. In response, the Last Days of Life Personalised Care Plan (LDoLPCP) was developed based on NICE guidance and the five Priorities for care of the dying person (LACDP, 2014) and its use audited.
Methods A focussed support and education programme was used to develop and phase in the LDoLPCP. It has been used in all acute adult wards (n=35) within the Trust since January 2017. From Jan-Jun 2017, an audit was carried out on a sample of notes of patients who had an expected death during an inpatient stay. Clinical notes were audited weekly using a pro-forma covering the five priorities for care of the dying person. The audit aimed to establish whether these patients had a LDoLPCP and if this was correctly completed. Data was collated anonymously and results analysed monthly and used in further education support.
Results There were 859 in-patient deaths, 267 patient notes included. In January 2017, 73.7% (14/19) showed documented evidence of recognition that the patient may die within the next few hours/days, increasing to 84.9% (28/33) in June. Compliance in using the care plan increased from 57.9% (11/19) in January to 72.7% (24/33) in June. Utilising user feedback and audit results, version2 of the LDoLPCP has been developed including an expanded emotional, spiritual and cultural needs section and how to explore these.
Conclusion The audit demonstrates the successful implementation of LDoLPCP with improvement in the number of people recognised as being in the dying phase having a personalised care plan. Weekly audits enabled concerns to be identified and education and support tailored to improve care plan use.
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