Background The Five Priorities of Care highlight the importance of individualised care planning for the dying adult. Ashford and St Peter’s NHS Trust is a district general hospital with over 1000 deaths per year. Over the last year, an individualised care plan based on the 5 priorities of care has been implemented across all wards. The initial baseline audit of care of the dying adult, lessons learnt from implementation and the re-audit of care are presented.
Methods A ward based training program was developed alongside a Priorities- individualised care plan document and communication sheet for family and loved ones.. An audit tool based on the 5 priorities of care was used to assess care of the dying before and after implementation across the acute hospital medical wards. Two weekly projects meetings were held during the implementation phase and data collected on the use of the ‘Priorities-individualised care plan’. The care of 50 patients before and after implementation was audited for comparison.
Results The initial audit showed recognition of dying on the wards ranged from 50%–100% however most patients were not recognised as dying until the last 48 hours, thus almost 80% of patients were unable to participate in decision making about their care. 5% of patients had adequate individualised care planning in the last days of life. Three months after implementation 31% of all medical deaths were supported with a Priorities care plan, however uptake varied across wards with the care of the elderly wards using it for over 60% of deaths compared to 15% on the acute medical unit.
Conclusion This quality improvement project highlights that implementing high quality end of life care through individualised care planning requires extensive training, resource and a culture shift for professionals. The post implementation audit findings will also be presented.
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