Authors (including presenting author) :
Chan LM(1), Ng JSC(1), Mak KN(1), Chiu PC(1), Ng TC(1), Tang LM(1), Lam YF(1), Leung KC(1), Ng HY(2), Ko PS(2)
Affiliation :
(1) Palliative care service, Department of Medicine, Haven of Hope Hospital,
(2) Nursing Services Division, United Christian Hospital.
Introduction :
Symptom assessment plays a crucial role in holistic care of patients with advanced illness admitted to palliative care (PC) units. Edmonton Symptom Assessment System (ESAS) is a screening tool for systematic assessment of severity of common symptoms, widely used in PC setting. However, variation in practice is noted due to (1) different wordings from translation from original ESAS in English and (2) different timeframe of assessment (e.g. symptom at the moment vs. symptom in the past 24 hours).
Objectives :
To standardize the practice in symptom assessment with consistent wordings and timeframe so as to optimize symptom management in a palliative care ward.
Methodology :
(1) Backward and forward translation on individual symptoms in ESAS was done in October 2020 by a group of 10 specialist doctors and nurses with experience more than 10 years in PC.
(2) Alignment in ward practice on the finalized exact wordings in Cantonese and on timeframe for symptoms assessment. The updated practice was piloted and further revised in November 2020.
(3) Training and implementation: (a) Training material in form of a PowerPoint presentation with narration on revised wording and guidance in practice using cue cards were generated for all existing and future clinical staff in PC ward. (b) Survey on feedback from nurses was done in February 2021 with final revision of wordings.
(4) Conduct serial audits in nurses in PC ward on compliance in wordings of symptoms and practice in using ESAS in PC ward.
Result & Outcome :
A revised symptom assessment form with recommended Cantonese wordings was derived and implemented in December 2020. In May 2021 and May 2022, 10 nurses of different rank and years of service were involved in each audit. The compliance in using the recommended Cantonese wordings were more than 96% in both audits, in which 6 out of 8 questions had 100% compliance. Compliance in following other recommendations in symptoms assessment was satisfactory (70 – 100%).
Conclusions:
The effort in standardizing symptom assessment would not only enhance quality of patient care, but in long run also facilitate capturing of patient outcome for service evaluation.
