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Update on the National Care of the Dying Audit 2014 from Dr Bill Noble of Marie Curie

Dr Bill Noble, Medical Director at Marie Curie speaks today on learning from the National Care of the Dying Audit 2014.

The results of the National Audit are available here

Findings from the report:

On organisation of care:

•Only 21% of sites had access to face-to-face palliative care services, seven days per week
•Most (73%) provided face-to-face services on weekdays only
•Mandatory training in care of the dying was only required for doctors in 19% of Trusts and for nurses in 28%
•2% provided 24/7 face to face palliative care
•82% of Trusts had provided some form of training in care of the dying in the previous year; 18% had not provided any.
•Only 47% of Trusts routinely capture the views of bereaved relatives or carers.
On Quality of Care
•87% recognition of patients being in the last days of life, but told less than half (46%) of patients capable of discussing this.
•Communication with family/carers about the imminent death of a relative/friend occurred in 93% of cases (average of 31 hours before the individual died).
•Most patients (63-81%) had medication prescribed 'as required' for the five key symptoms common at the end of life - pain, agitation, noisy breathing, difficulty in breathing, and nausea and vomiting.
•59% of patients were clinically assessed to see if they needed artificial hydration, but discussions recorded with 17% of ‘capable’ patients and 36% of relatives.
•Artificial hydration was in place for 29% of patients at the time of death.
•45% of patients were clinically assessed to see if they needed artificial nutrition, but discussions only recorded with 17% of ‘capable’ patients and 29% of relatives.
•Artificial nutrition was in place for 7% of patients at the time of death.
•Only 21% of ‘capable’ patients were asked about their spiritual needs, and only 25% of relatives/carers asked about their own needs.
•Most patients - 87%, were assessed five or more times in the final 24 hours of life, in line with national guidance.
Findings from bereaved relatives survey
•76% reported being very or fairly involved in decisions about care and treatment of their family member
•24% did not feel they were involved in decisions at all.
•39% of bereaved relatives reported being involved in discussions about artificial hydration in the last 2 days of life.
•63% reported that the overall level of emotional support given was good or excellent. 37% thought it fair or poor.
•Overall, 76% felt adequately supported during the patient's last 2 days of life; 24% did not.
•Based on their experience, 68% were either likely or extremely likely to recommend their Trust to family and friends. 8% were extremely unlikely to do so.
Future focus:
1.We need to focus on two groups of people:
–Those who clinically need to be in hospital
–Those who could and want to be elsewhere

2.   For the first group we need to drive up the quality of care - helped by better auditing and measuring of experiences


3.   Improve interventions which prevent people who do not need/want to be there from ending up in hospital and getting them out when they end up there.

Scroll down for presentation slides

Improving End of Life Care
Wednesday 10 December
Manchester Conference Centre

Download: Bill Noble Presentation

15 September 2014


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