Care for patients who are reaching the end of life Royal United Hospital, Bath, NHS Trust

It is important that clinicians identify when patients are nearing end of life and communicate this to the patient and their family, allowing them to be involved in appropriate decision-making. However this can be difficult for clinicians and a worrying, anxious time for patients and their family.

The project aimed to ensure better identification of end of life, and to enable staff to better manage uncertainty and support patients and families by engaging in regular dialogue.

This was achieved by:

• regular honest, open and supportive discussions between clinicians and patients and families about the management of their illness
• improved multidisciplinary working that allowed for open discussion between staff about the patients’ condition, accepting and valuing everyone’s opinion in identifying end of life.

The key action taken to identify the changes needed was to record when a patient was identified as approaching end of life, where and when that decision was made, and by whom. The team then captured the result of that decision and the action taken by the ward staff. This meant they could identify workable indicators for an acute ward, and identify difficulties and barriers staff faced in the management of care, and the actions needed to assist them.

Holding an event for staff on the ward helped create a two way dialogue about the issues and ideas on how to go forward.

The care pathway developed included:

• maintaining the involvement of family and patient in the decision-making
• reducing length of stay by improving the focus and co-ordination of care
• liaison with community staff, giving the right information to the right people
• helping patients and their families prepare for the future
• preventing unnecessary admissions
• arranging appropriate care.

Other areas of work that supported the project included:

• an after death audit
• the use of a discharge tool
• adopting the themes from the ‘Amber care bundle’.