P-124  Preferred place of care – root cause analysis. Issue Volume 6: Issue (2016)Supplement 1 (1st November 2016)

• Record Type: Journal Article
• Authors: Debattista, Maria; Fletcher, Andrew; Capewell, Claire
• Is Part Of: BMJ supportive & palliative care. Volume 6: Issue (2016)Supplement 1
• Page Start: A55
• Page End: A55
• Publication Date: 2016-11-01
• Subjects: Palliative treatment -- Periodicals; Terminal care -- Periodicals; 616.029
• DOI: 10.1136/bmjspcare-2016-001245.147
• Languages: English
• ISSNs: 2045-435X

Abstract

Abstract : Introduction: Surveys and research indicate that home is the preferred place of care at the end of life for many people (71%), whilst the most commonly recorded place of death remains hospital (53%). Aim: To identify barriers and enablers to the delivery of good end-of-life care for patients. Methods: The project was completed over a six-week period at a hospice in Northwest England. Each week at our multidisciplinary team meeting we discussed deaths of patients known to our community palliative care team and recorded our findings. Results: 48 patients known to the team died during the six- week period. Preferred place of death was achieved in 91% (30/33) of cases when this was home, and 85% (11/13) of cases when this was the hospice. None of our patients expressed hospital as their PPD. Preferred place of death was unknown in 4.2% (2/48) of patients. 8.3% (4/48) of patients died in hospital. In 50% (2/4) patients, a hospital admission was indicated due to acute unexpected deterioration. 77% (21/27) of patients dying in the community had face to face or telephone contact within three days of death. Identified barriers to good end-of-life care were: difficulties accessing oxygen at home for symptom management, one episode of difficulty accessing specialist care advice and challenges communicating directly with district nursing teams. Enablers were: appropriate use of DNACPR forms with no involvement of emergency services at the end-of-life as well as good team-working between specialist and generalist services. Conclusions: The majority of patients known to the team die in their preferred place of care, with a good quality of death as judged by the team. Lessons have been learned from after death analysis and action plans devised. This scoping exercise could be repeated on a periodic basis.