National Care of the Dying Audit January 3, 2008
Posted by western4uk in Acute Services, Carers, Grey Literature, Hospitals, Palliative Care, Patient Information, Primary Care, Quality of Life, Supportive Care.Tags: Acute Services, Assessment, Carers, Communication, Drug Therapy, Ethics, Grey Literature, Hospitals, Information Systems, Liverpool Care Pathway, Pain, Palliative Care, Psychology, Quality, Religion
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National Care of the Dying Audit generic report 2006/2007 considers the care of the dying in five key areas and finds that:
Physical Comfort of the Patient
- Medication was assessed and non-essential medication was stopped in 93% of patients.
- Anticipatory prescribing was undertaken for pain relief in 91% of cases, for agitation in 84% of cases, for the prevention of respiratory tract secretions in 80% of cases, for nausea in 80% of cases and for breathlessness in 67% of cases.
- Inappropriate blood tests and antibiotics were discontinued in 87% and 91% respectively, and recording of ‘not for Cardio Pulmonary Resuscitation’ (where appropriate) documented in 93% of patients.
- In regard to ongoing care the presence or absence of symptoms could be recorded for patients during the last 24 hours of life. The status was not recorded for 18% - 19% of those assessments. Where the status was recorded patients were assessed as being symptom controlled in 95% for pain; 94% for agitation; 91% for respiratory tract secretions and 99% for nausea and vomiting of occasions.
Psychological and Spiritual Aspects of Care
On commencement of the LCP (Initial Assessment)
- Patient awareness of diagnosis and recognition of the dying phase was recorded as having been achieved in 57% and 45% of patients respectively. In one third of cases there was no documentation on the LCP suggesting a need for further education and training for healthcare staff. Some hospitals, however, did achieve 100%.
- In over 80% of cases, carers were recorded as being aware of the diagnosis and dying phase, suggesting that healthcare staff find it easier to talk to carers
- The spiritual needs of patients and carers were recorded as being assessed in 34% and 53% (respectively) of appropriate cases
Communication with Patient,Carer and Healthcare Professionals
This is variable but carers were more likely to have had the care plan explained to them than the patient:
- At Initial Assessment, documentation confirmed that patients had the care plan communicated to them in over one third of cases, compared with 78% of carers. It was recorded that 90% of those carers understood the care plan after it was explained to them.
- Communication with primary care (both on commencement of the LCP and after the death of the patient) was documented as having taken place in only about a third of cases, although there were pockets of good practice
Information Giving and Receiving
- Contact information about the most important person to contact in case the patient’s condition deteriorates was achieved at Initial Assessment in 79% of cases and Hospital information leaflets regarding facilities and access were given out in 59% of cases at that time
- Around the time of death or deteriorating condition of the patient (Initial Assessment), only half of families were recorded as having been given appropriate information about local and national procedures that may need to be followed.
Following Appropriate Procedures
- Following death, appropriate hospital procedures for laying out of bodies, storing of patient’s belongings and other activities were documented as having been followed in around half of cases. However, the high level of care after death goals that are left blank at the point of delivery of care requires more investigation before firm conclusions can be made.
my mother is dying in kingston hospital in surrey and ive been told that lcp was stated last monday. how and what is administed/given to my mum? ive read and understand the concept from various websites but nothing states how lcp is done.
could you please answer by today before mum passes away.
thank you.