Background Evidence shows that routine measurement of patient-reported outcomes (PROMs) is important in palliative care (Bausewein, Daveson, Currow, Downing et al., 2016; Collins, Witt, Bausewein, Daveson et al., 2015). Increasing emphasis is placed on PROMs by those who commission services (Bausewein, Schildmann, Rosenbruch, Haberland et al., 2018).
IPOS is a patient-reported outcome questionnaire in a suite of six palliative care-specific measures developed by the Outcome Assessment and Complexity Collaborative (OACC). OACC recommend a phased implementation (Witt, de Wolf-Linder, Dawkins, Daveson et al., 2015; Dawkins & de Wolf-Linder, 2015).
Aim Embed three measures from the OACC suite into clinical practice in our service.
Method Phased implementation began with identification of IPOS champions for each service area. Champions received training on Phase of Illness (POI) and Australia-Modified Karnofsky Performance Status (AKPS). Email communication was sent to all staff regarding OACC. Posters were displayed and project team members were available to answer questions. POI and AKPS were then routinely recorded across the service.
A training package was devised and delivered to all staff on using IPOS with patients. Community teams implemented IPOS into clinical practice first, followed by the inpatient units.
Initial audit used a randomised purposive sampling approach to obtain a sample of 10% of the caseload over the initial three month period which included patients from all service areas. The patient records for these patients was then reviewed using a standardised proforma to determine whether IPOS had been considered and completed where appropriate.
Results 84% of patients had at least one IPOS considered. IPOS was not considered at only 36% of encounters.
IPOS is now completed weekly and reviewed in MDT for all inpatients. It is considered at each encounter for community patients. Responses are used to guide clinical decision-making.
Conclusions Appropriate use of IPOS was much higher in our implementation period than reported for other services (Bausewein, Schildmann, Rosenbruch, Haberland et al., 2018).
We attribute this success to the quality and structure of staff training, phased implementation and to the visibility of the project team throughout the implementation process (Antunes, Harding & Higginson on behalf of EUROIMPACT, 2014).
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