Background Royal Surrey County Hospital (RSCH) has implemented a Personalised End of Life Care Plan (PELiCan) designed to assess the needs and symptom control of patients in the last seven days of life. This audit aimed to assess how regularly and thoroughly the documents were completed.
Method PELiCan documents were reviewed for all patients who died in RSCH with a PELiCan in place from 1 August to 30 September 2017. Of particular interest were: completion of the Personal Care Plan on Day One; next of kin contact details documentation; and Medical Day One Assessment, which reviewed whether patient and carers were aware of the terminal prognosis and whether preferred place of death (PPD) had been discussed. Multidisciplinary team entries were also audited to confirm that the Supportive and Palliative Care Team (SPCT) had reviewed patients daily, including on weekends and Bank Holidays. Also, drug charts were assessed for key medications in symptom management.
Results 68 patients died with PELiCan pathways in place. 63 of 68 (92.65%) were reviewed daily by the SPCT between starting a PELiCan and their death. Contact details were recorded in only 44 of 68 documents (64.71%), and PPD, in 46 of 68 documents (67.65%). However, the carer was documented as aware of the prognosis in 63 of 68 documents (92.65%).
Conclusion The trust met its internal target (90%) for SPCT reviews and carer notification of prognosis, but fell short in documenting PPD. Reviewing the notes, it is feasible that important discussions with families were taking place, but remained insufficiently documented. The authors intend this audit to be developed into a quality improvement project which will familiarise ward teams with PELiCan documentation and the most important areas for completion. The audit will then be repeated.
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