The Five Priorities of Care : improving clinical practice in care of the dying person. Andrea Hanson Macmillan/STH End of Life Care Facilitator

Transcription

1 The Five Priorities of Care : improving clinical practice in care of the dying person Andrea Hanson Macmillan/STH End of Life Care Facilitator

2 This session will include.. Exploring whether care of the dying has improved following the report One Chance to get it Right referring to the Voices audit for recently bereaved relatives 2016 & the Royal College of Physicians National end of life care audit 2015 Working in groups recognise the importance of individualised care in the dying phase by exploring the needs and wishes of self and colleagues

3 VOICES survey of recently bereaved people: key findings The findings for 2015 are almost identical to those from the 2014 audit Very little is changing What is good remains good, what is poor remains poor Leadership across all areas & all levels of heath service provision needs to make end of life care a core priority

4 Overall quality of care in the last 3 months of life, England, 2015

5 Royal College of Physicians End of Life Care Audit March 2016 Overall shows steady progress in care of the dying people since the audit in 2013 published 2014 All participating organisations have their own individual report. This is the first audit since withdrawal of the LCP in 2014 Much more detailed audit measures care of dying people against the Five Priorities of Care Audit tool has changed since 2013

6 RCP audit 2016: Key Findings 93% of predictable deaths had documented recognition that they were dying (87% in 2013) with senior doctor involved in 76% of cases Doctors are more likely to discuss dying with relatives than the patient Due to their condition, 63% of patients were unable to discuss dying with a Healthcare professional. 13% patients who were able to have discussions did not have them.

7 Pre- emptive Prescribing in place Documented evidence of: Pain 81% 75% Agitation or delirium Breathing Difficulties Nausea & Vomiting Noisy breathing/death rattle 72% 69% 65% 66% 68% 66% No data available 62%

8 Documented evidence of : Ability to drink assessed Needs of Patients No previous data 67% Supported to drink No previous data 45% Need for clinically assisted hydration Clinically assisted hydration in place in last 24 hours of life Opportunity for patient to have concerns listened to 59% 71% 29% 43% No previous data 32%

9 Needs of those Family/ those close to the patient Documented evidence of: Discussion that patient was dying Patients needs discussed with family Needs of family those close to the patient were asked about Family were notified of the imminent death Family present at time of death 93% 95% No data available 38% 25% 54% No data available 63% No data available 65% *** wide variance between different sites

10 Conclusions Slightly differing findings in both national audits Evidence of improvements in some areas but not others however significant improvement is still required. Quality of care differs in different locations Individual trusts need to make improvements

11 Conclusions (continued) Care of the dying has no respect for time, access to Specialist Palliative care 24/7 is essential Funding must be directed towards recruiting nurses & doctors to deliver specialist care

12 References National Survey of Bereaved people (VOICES) England (2015) : Quality of care delivered in the last 3 months of life for adults who died in England mmunity/healthandsocialcare/healthcaresystem /bulletins/nationalsurveyofbereavedpeoplevoice s/england2015

13 References (continued) One Chance to get it Right ( 2014) nce_to_get_it_right.pdf Royal College of Physicians (2016) End of Life Care