77 Improving recogntion and end of life care coordination across 3 ccgs. evaluation of our service

Abstract

103 anticipatory medications administered 18.4% (19 out of 103 medications) had documentation of the effect on symptoms. There were 24 patients admitted to the specialist palliative care beds for end of life care over a 6 week perios, of which 21 had anticipatory medications administered. Of these patients 31.6% (18 out of 57 medications) had documentation of the effect on the patient's symptoms. Conclusions This study demonstrates that the effect of anticipatory medications is poorly recorded in the nursing notes on wards in a district general hospital. However, there is improvement when the patient is managed in a specialist palliative care bed on a general hospital ward. Further training is required to improve this documentation and allow accurate monitoring of symptoms. The designated specialist palliative care bed model may provide an opportunity for training of nurses across the hospital. Introduction Prescribing medications for patients 'to take out' (TTO) on discharge is a routine task for junior doctors. Prescribing end of life care medications as a TTO, such that a rapid discharge can be arranged for a patient wishing to die at home, is not so common. Inspiration and aim Born out of a highly emotive incident in which a patient did not receive his medications, a project to test, and subsequently improve, the accuracy of TTO prescriptions of these medications was initiated. Method A cohort of foundation year one doctors undertook an end of life care prescribing quiz (Quiz 1), asking them to give an example prescription for both controlled and non-controlled drugs, and to state any additional documentation required to validate the prescription in the community. A guideline was then created in collaboration with the palliative care team, junior doctors and pharmacists to improve the accuracy of TTO end of life care medications. The new guideline was delivered alongside a palliative care teaching session, with cross-reference to the Trust's palliative care guidelines. The same cohort of doctors then re-took the prescribing quiz (Quiz 2).Results The results of Quiz 1 highlighted worrying prescription inaccuracies: only 5% (1/20) of doctors correctly prescribed the medications and only 10% (2/20) identified the need for a community prescription chart. After guidance and training there was a considerable improvement in prescription accuracy (Quiz 2), with 75% (15/20) of doctors correctly prescribing the medications, and 88% (17/20) identifying the additional chart needed for administration. Future Going forward, the guideline is to be distributed to all junior doctors within the trust, through inclusion on the intranet and the introductory handbook, such that future situations of delayed dispensing of end of life care medications can be avoided. 1 CCG now has 68% of all deaths (90% 'predictable' deaths) identified, registered on EPaCCS and receiving care. This CCG also has the lowest% hospital deaths in England. One CCG is less well engaged. Discussion Multiple interventions to identify, communicate and provid...