Sarah Qasim
Sheffield Teaching Hospitals NHS Trust, United Kingdom
Title: An Evaluation of Quality in End of Life Care within Oncology at LTHT
Biography
Biography: Sarah Qasim
Abstract
Background: The end of life care (EOLC) quality standard from the National Institute for Health and Care Excellence (NICE) [QS13] emphasises the importance of timely identification and holistic assessment of those approaching the end of life.[1] Furthermore, the Leadership Alliance for the Care of Dying People has recommended ‘personalised palliative care plans’ for patients with progressive, life-limiting illness .[2] Recently, a screening question concerning EOLC has been introduced within the Mortality Review Screening Tool in the Leeds Teaching Hospitals NHS Trust (LTHT), which may provide an indicator for quality of EOLC but has not been evaluated.
Aims: This audit aims to assess the quality of care of Oncology patients who have died within LTHT, to establish whether the current screening tool is fit for purpose and promote local quality improvement. The standards used are six priorities of care identified by LTHT.
Method: Retrospective data was collected from case notes using an audit toolkit (provided by LTHT) from ten patients (n = 10) within the specialty of Oncology, who had died as inpatients between October and November 2018.
Results: All ten patients were known to have advanced progressive disease and the Oncology team recognised risk of dying or when death was imminent in all cases. In nine out of ten cases DNACPR had been discussed directly with the patient. All patients had documented escalation plans by a senior physician in the medical notes. Nursing teams were better than medical staff at documenting psychosocial and hydration needs.
Conclusions: Specific tutorials or e-learning modules for medical staff may help to refresh understanding of the important issues surrounding end-of-life care. Emphasis on medical staff completing a full initial assessment of EOLC needs and wishes, prior to commencing palliation, is recommended. Finally, re-audit will be necessary to assess whether the current standards are being met.