Background Following CQC inspection, need for improvement in recognising dying/individualised care planning in one acute NHS trust was highlighted. In response, the Last Days of Life Personalised Care Plan (LDoLPCP) was developed based on NICE guidance and Five Priorities for care of dying person. Implementation audited via multiple methods.

Methods

• Retrospective cross-sectional monthly spot audits Nov 17–Apr 18 in two acute hospitals. Those on LDOLCP identified from SPCT current case-list, ward visits & mortality database/bereavement office data. 10 care plans reviewed monthly each site. Two clinicians assessed quality of documentation using a standardised audit tool. Areas covered include: recognition, senior decision maker, anticipatory prescribing etc. Each section subjectively rated (High standard, acceptable, needs improvement, poor). Data collated anonymously. Results analysed using summary statistics. Target level for standards set at 80% of plans completed to a high/acceptable level.

• Online survey questionnaire emailed to all Trust frontline staff to ascertain views/feedback on LDOLPCP. Qualitative feedback gained from frontline Nursing staff on 20 wards cross-site.

Results

• 110 care plans reviewed. Mean age 82 years, 56% female. In 73% (80/110), section on recognition of dying completed to high or acceptable level. Highest scores: 83% for documentation of senior doctor & 92.9% for anticipatory prescribing for pain & nausea. However in other areas, results fell below target including Emotional/spiritual/cultural assessment 36.7%; daily symptom assessment 43.0% and Hydration status assessed, 48.5%. Reasons for poor quality documentation include uncertainty over whom best to complete, time pressures, LDOLPCP viewed as one-off document rather than an evolving plan.

• Online survey in progress & reaudit – results to follow.

Conclusion Audit shows areas of mixed quality documentation. Through staff engagement, targeted improvement areas include better MDT communication and shared responsibility, earlier in-patient emotional/spiritual assessment, developing model LDOLCP examples as resources/benchmark the results are expected to improve.