Authors (including presenting author) :
Tang LM (1), Mak KN (1), Ng JSC (1) Ko PS (2)
Affiliation :
(1)Palliative Care Service, Department of Medicine, Haven of Hope Hospital
(2)Nursing Services Division, United Christian Hospital
Introduction :
There are 700 deaths in Haven of Hope Hospital (HHH) annually. To provide quality care for dying patients, an “End of Life (EOL) Care Reminder for Patients in the Last Days of Life” was designed by palliative care service and has been implemented in all wards since 2018. It is a checklist to remind nurses and doctors on physical, psycho-spiritual and social needs of dying patients (with DNACPR order) and their families and on goals of care communication. An audit and an online staff survey were conducted to evaluate the compliance and feedback on the use of the care reminder.
Objectives :
1. To audit the usage and compliance of the EOL care reminder and the reasons of not using it
2. To collect feedback from doctors and nurses on use of EOL care reminder and their experience in care of dying patients and families
Methodology :
Audit on use of the care reminder was conducted by EOL link nurses in individual wards between 1 Dec 2020 to 31 Jan 2021 (2 months) Online staff survey inviting all frontline doctors and nurses was conducted between 24 May to 7 Jun 2021 (2 weeks).
Result & Outcome :
There were 152 deaths in the audit period. EOL care reminder was initiated in 66% (101/152 deaths) of cases. For patients with care reminder initiated, majority (92%) died within 7 days. The main reasons of not initiating the care reminder are (1) unanticipated rapid deterioration and (2) unanticipated cardiac arrest.
203 respondents (43% of doctors and 73% of nurses in HHH) participated in the survey. 55% (112 respondents) had used the care reminder more than 5 times. Nearly all respondents agreed the care reminder were user-friendly (97%) and effective (96%). Staff reflected the need for more training in (1) dealing with patient or family with “anger & grief”, (2) handling “distrust” towards healthcare professionals and (3) identifying high risk complicated grief. Conclusion: Good compliance and effectiveness were shown in using EOL care reminder. It is a user-friendly tool to enhance quality of EOL care for patients and their families.
