Choice surrounding place of death (PPD) is a fundamental component of a good death, with NICE quality standards for end of life care stating that all patients should have their needs and preferences regarding this assessed. In an initial audit to determine whether RSCH palliative care inpatients had had an opportunity to discuss preference for place of death, results showed we did not meet our standard (set at 100% of patients having had this opportunity, or a valid reason documented as to why not). Less than 50% had a documented PPD, and less than 75% had a valid reason why not. To complete the audit cycle, this re-audit looked at outcomes following changes made to assessment documentation and team education, and compared to the initial results.
Data collected from palliative care inpatients May 2017 – June 2017 (N=226) regarding PPD documentation, and compared to initial data October 2016 – January 2017 (N=274).
The target of recording a PPD or a valid reason for its omission was achieved in 168 (88.4%) patients, a slight increase compared to initial audit (84.5%). For patients who died, death at their PPD was achieved in 76.0% – an increase from 67.6%.
Though not meeting it, outcomes in the second cohort of patients were closer to the set standard than in our initial data, suggesting successful intervention. Mandatory documentation and discussion of PPD earlier in the healthcare journey are further suggestions to improve this. Despite commenting on numbers of patients meeting their PPD, we did not develop or analyse this information further and feel this could be a point for further audit or QIP.
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