A good death: A complete audit cycle of end of life care in the intensive care unit at the hammersmith hospital

2020 
Introduction: Despite advances in medicine, death rates in Intensive Care Units (ICU) remain high (1) ICU patients are admitted for life saving organ support;however when this fails, it is vital to provide patients with dignified deaths The ICU brings about unique circumstances that make palliative care challenging, highlighting the importance of auditing current practices The aim of this project was to audit the provision of end of life care, identify areas for improvement and develop interventions to ensure we provide optimum care This was particularly important during the COVID-19 Pandemic surge where we had higher than average ICU mortality rates and unique sets of challenges Interventions included raising awareness through multidisciplinary education at various forums We increased awareness of existing available tools such as electronic end of life care forms and prescription order sets Trainees also had access to electronic copies of simple guides to facilitate discussions with patient and their families (2) Videoconferencing proved invaluable in allowing spiritual and psychological support for parents and their families Methods: A retrospective initial audit was carried out by reviewing the electronic medical records (ISCCA) of patients who died between April and September 2019, following the implementation of interventions, a re-audit was carried out between March and May 2020 Data was collected based on NICE and FICM guidelines for end of life care and summarised into 6 main criteria (3,4,5) This included;Identification of dying patients, Treatment escalation and Resuscitation planning, Patient and Family Involvement, Symptom management, Comfort care, and Psychological and Spiritual needs The data was analysed using simple statistical tests Results: There were 61 deaths during the initial audit period and 28 during the re-audit The re-audit showed 93% (92% initial audit) of patients were identified as dying in a timely manner with 86% having clearly documented treatment escalation and appropriate resuscitation planning 93% (77% initial audit) of patients had clearly documented Patient and Family Involvement with end of life discussions Spiritual & Psychological support and Comfort Care was documented in all patients This was a significant improvement compared to 41% for Spiritual & Psychological support and 26% for Comfort Care recorded in the initial audit Symptom management also significantly improved from 13% to 100% Conclusion: Despite the additional challenges posed by the COVID- 19 Pandemic these results show our ICU Team continued to provide high quality and compassionate End of Life Care 6 We intend to continue carrying out multidisciplinary teaching sessions with input from Palliative care and Pharmacists We will also encourage the use of the palliative care form on ISCCA to provide prompts and enable accurate documentation A laminated aide memoire flow chart (4) will also be available in clinical areas End of life care is an essential skill for all members of the critical care team, because a good death is as important as a good life (4)
    • Correction
    • Cite
    • Save
    • Machine Reading By IdeaReader
    0
    References
    0
    Citations
    NaN
    KQI
    []