Setting

This audit is particularly relevant to older-adult in-patient units where terminally ill patients suffering from dementia are placed.

Background

The Human Rights Act 1998 imposes an obligation to facilitate a good death. Despite the fact that it is difficult to define a ‘good death’, pathways have been developed to help patients make their final transition with the least distress. One such pathway is the Liverpool Care Pathway for the Dying Patient (Marie Curie Palliative Care Institute, 2007). It uses the National Gold Standards Framework, which is a systematic, evidence-based approach to optimising care for patients nearing the end of life. This audit is important because the Department of Health's end-of-life care strategy states that ‘every organisation involved in providing end-of-life care will be expected to adopt a co-ordination process, such as the Gold Standards Framework’ (Department of Health, 2008).

Standards

Standards were obtained from the Liverpool Care Pathway for the Dying Patient (Marie Curie Palliative Care Institute, 2007):

ᐅ recognition of the terminal stage and documentation in notes

ᐅ decision not to resuscitate (DNR) discussed with next of kin and documented

ᐅ discontinuation of non-essential drugs in terminal phase

ᐅ unnecessary investigations not to be carried out

ᐅ unnecessary monitoring of vital signs to be stopped

ᐅ use of medication as required to relieve distressing symptoms

ᐅ general practitioner informed of patient's death.

Method

Data collection

Data were retrospectively collected from medical notes, prescription cards and temperature, pulse rate and respiratory rate (TPR) charts, for all patients who had died on in-patient wards/units with terminal dementia in the past 2 years. The medical notes, prescription cards and TPR charts were examined to find documentation of the seven standards listed above.

Data analysis

The percentage of patients who had received terminal care as outlined by the guidelines was calculated and tabulated.

Resources required

People

It is suggested that this audit is undertaken by at least two people, because suitable patients may be placed on different wards.

Time

The collation of notes and collection of data from nine suitable cases in the first cycle of the present audit took one person around one working day.