9 Delivering good quality end of life care (EOLC) during a pandemic: the response of the transforming end of life care team (TEOLCT) to COVID-19 in an acute London NHS trust. Issue Volume 11: Issue (2021)Supplement 1 (16th March 2021)

• Record Type: Journal Article
• Authors: Soosaipillai, Gehan; Bennetts, Joanne; McMillan, Madeleine; Pereira, Lina; Padmore, Finn; Iqbal, Sadaf; Collis, Emily
• Is Part Of: BMJ supportive & palliative care. Volume 11: Issue (2021)Supplement 1
• Page Start: A11
• Page End: A11
• Publication Date: 2021-03-16
• Subjects: Palliative treatment -- Periodicals; Terminal care -- Periodicals; 616.029
• DOI: 10.1136/spcare-2021-PCC.27
• Languages: English
• ISSNs: 2045-435X

Abstract

Abstract : Introduction: The COVID-19 pandemic highlighted the need for high quality EOLC, unprecedented in scale and setting. We describe the initiatives led by the UCLH TEOLCT who played a key role in preparing and supporting staff to provide EOLC, as well as providing support for inpatients and their families. Methods: Utilising QI methodology, the TEOLCT rapidly implemented changes in six key areas of practice between 23/03/2020 and 25/08/2020. The multidisciplinary TEOLCT collaborated with Specialist Palliative Care and Clinical Psychology teams to achieve these outcomes. Results: (i) Staff education: high demand for teaching, e.g. difficult conversations, EOLC and COVID-19 specific symptom control, for redeployed staff largely inexperienced in EOLC. 1037 clinical staff were trained utilising a combination of socially distanced lectures and video-conferencing/webinars. (ii) Staff support: drop-in sessions were facilitated for >200 staff members. (iii) Guidance and Standard Operating Procedures: for symptom control, non-invasive ventilation withdrawal and communicating with family were collaboratively written and disseminated with appropriate training. (iv) Clinical audit: quality of decision-making and documentation scrutinised by auditing treatment escalation plans and do not attempt cardiopulmonary resuscitation orders, identifying areas of practice improvement and training needs. (v) Clinical support: modifying the SWAN model of care for patients in last days of life, TEOLCT supported care of 107 patients during the pandemic peak (23/03 '' 15/05/2020), totalling 255 inpatient visits. (vi) Bereavement support: with restricted visiting and changes to after death care, TEOLCT oversaw formal bereavement support for bereaved families of 348/392 patients who died, plus appropriate sign-posting to community services. Conclusions: The TEOLCT rapidly adapted to an unprecedented clinical challenge, identifying and responding to needs, working towards a common goal and leading a coordinated response to the demand for training and support. The key areas of development will inform future practice to ensure ongoing training and support in future surges.