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Learning from the National Care of the Dying 2014 Audit

Learning from the National Care of the Dying 2014 Audit. Dr Bill Noble Medical Director, Marie Curie Cancer Care. M arie Curie. Major UK end of life charity

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Learning from the National Care of the Dying 2014 Audit

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  1. Learning from the National Care of the Dying 2014 Audit Dr Bill Noble Medical Director, Marie Curie Cancer Care

  2. 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.

  3. Delivering High Quality Services

  4. Commitment to research • Increasing research budget - £3.4 million – rising to £6.8 million over the next five years • 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) • Focus on all terminal conditions.

  5. 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.

  6. National Care of the Dying Audit Draws on three sets of data: • Individual patient records (6580 people who died in 149 hospitals in England – 1st-31st May 2013) • An assessment of organisational readiness to deliver palliative and end of life care • Views of 858 bereaved relatives.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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

  12. Future Focus • 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.

  13. Thank you FOR YOUR TIME

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