Learning From the National Care for the Dying 2014 Audit
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Learning from the National Care of the Dying 2014 Audit
Dr Bill Noble Medical Director,Marie Curie Cancer Care
MARIE CURIE
• Major UK end of life charity • Major service provider – Network of 2000 Nurses caring for
people in the last few hours and days of life – 1.3 million hours of nursing in 2012-13
• 9 hospices across the UK reach 8,000 people each year• Our services reached a total of 38,777 people in 2012-13• Major funder of academic and health service research with an
Open Access research policy • Working to influence policy and practice through our policy
and public affairs work.
DELIVERING HIGH QUALITY SERVICES
COMMITMENT TO RESEARCH
1. Increasing research budget - £3.4 million – rising to £6.8
million over the next five years
2. Three dedicated research centres:
• Marie Curie Palliative Care Research Centre, Cardiff
• Marie Curie Palliative Care Institute Liverpool
• Marie Curie Palliative Care Research Unit, London,
University College London (UCL)3. Focus on all terminal conditions.
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National Care of the Dying Audit
• The National Care of the Dying Audit for Hospitals
• Carried out by the Royal College of Physicians, with the Marie
Curie Palliative Care Institute Liverpool
• Funded by Marie Curie and Public Health England.
National Care of the Dying Audit
Draws on three sets of data:
1. Individual patient records (6580 people who died in 149
hospitals in England – 1st-31st May 2013)
2. An assessment of organisational readiness to deliver palliative
and end of life care
3. Views of 858 bereaved relatives.
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.
Findings on the quality of care (1)
• 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.
Findings on the quality of care (2)
• 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.
Key Issues Highlighted
• Lack of access to face to face palliative care
• Lack of 24/7 support
• Poor communication with individuals and their families• Even it was recognised that someone needed artificial
hydration/nutrition, there is too often no communication about this
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.
THANK YOUFOR YOUR TIME
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