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 https://www.rcplondon.ac.uk/sites/default/files/ncdah_national_report.pdf
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.
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.
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Download: Bill Noble Presentation
15 September 2014