64 The quality of documentation in the care plan for end of life in a district general hospital: a quality improvement project

Abstract

Quality Statement 8 of NICE Quality Standards ‘End of Life Care for Adults’ (2017) highlights the importance of coordination of care between different healthcare professionals. In Macclesfield District General Hospital, a patient’s end of life care is documented in a specific Care Plan for end of life, containing 7 different sections. In order to ensure that all health and social care professionals are aware of patients’ individualised plans of care at the end of life, daily reviews by all HCPs should be documented within section 6 (Individualised care and daily nurse review) of the EOL care plan. A baseline audit of documentation within the care plan for one month noted a lack of consistency in the location of HCP documentation. Daily reviews could be documented in the medical notes, nursing notes or within the care plan. This was felt to negatively impact upon the coordination of care for dying patients within the hospital. In order to improve the consistency of documentation within section 6 of the care plan a sticker was introduced with the same colour as the care plan into medical and nursing notes when a patient commenced on an end of life care plan, which directed all HCPs to document within section 6 of the care plan. A re-audit of the notes of all deaths on a care plan over one month was carried out following this intervention. In total the care plan was used for 12 patients and the sticker used in 8 of those deaths (66%) Documentation within section 6 of the care plan improved with the use of the sticker, however, within the hospital the use of the care plan in general is inconsistent. This QIP has highlighted the need for review of EOL documentation and ongoing education and training.