Efficient, comprehensive documentation is a vital element of all healthcare provision. It not only provides a record of care, but should reflect the quality of that care, enable continuity of care between practitioners and reinforce care standards. However, documentation in palliative care often falls short of these ideals. This article describes the formulation of an integrated system of documentation which aims to address the failings of documentation procedures in one hospice/palliative care unit. The resulting system seeks to embody the rationale of palliative care within a dynamic, patient-centred approach to nursing documentation.
The authors outline the benefits of an initiative piloted at North Tees and Hartlepool NHS Foundation Trust. Family members of people at the end of their lives are asked to fill in diaries to provide feedback about care, and the information is used to address issues raised. The data and comments are collated, audited and fed back to clinical staff and managers across the trust to benchmark patient-reported outcome measures and quality markers for achieving a 'good death'. The term 'family' refers here to family, friends, carers and significant others who are present at the bedside of patients who are dying in hospital and who are on the Liverpool Care Pathway.
Background: Acute hospitals provide a high proportion of end-of-life care but some families experience poor communication with clinical staff. Aim: To evaluate the use of the Family's Voice diary communication tool across nine healthcare settings. Methods: A mixed method practice development approach was used incorporating: an audit of the usage of Family's Voice; collation and analysis of written comments; and collation of written feedback from the principal investigators at data collection sites. Findings: There were 112 completed diaries. Families rated pain and vomiting as well controlled, but agitation and breathlessness were difficult to control. Families were positive about care provided to the patients and themselves. Ten themes were identified from analysis of the families' written comments that echoed national concerns. Conclusion: Evidence for the utility of the diary is building. Future work could focus on strategies for embedding the diary into routine care for all end-of-life patients.
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