A symptom observation chart to support an individualised approach to care for dying patients in hospital
From July 2013, the Liverpool Care Pathway for dying patients was gradually withdrawn in response to an independent review.1 Since this time, there has been a necessary progression towards providing more individualised care to patients in the final hours and days of life. Initially, this was shaped by the Leadership Alliance for the Care of Dying People, whose publication One chance to get it right2 brought focus to five key priorities for the care of such patients. With this timely shift, healthcare professionals developed local practices to support the implementation of this improved approach. The last 2 months have seen the publication of the Royal College of Physicians’ acute care resource: End-of-life care in the acute setting3 and the National Institute for Health and Care Excellence guidance: Care of dying adults in the last days of life.4 As such, the blueprint for how the treatment and care of all dying patients should be approached has become firmly laid down.
We hereby write to share a local initiative developed and used to support this process: a ‘symptom observation chart for the dying patient’. Developed in the acute setting, this chart (with accompanying guidance) is employed once a patient is recognised as dying. Analogous to a National Early Warning Score chart in format, it has been adopted easily by the multiprofessional team. Its purpose is to:
facilitate the regular and standardised assessment of patient comfort
create a record of symptom control over time, which can help inform necessary adjustments to the individualised care plan
encourage communication between members of the multiprofessional team by, for example, providing a clear framework for escalating and requesting urgent medical review if symptoms are not controlled by the existing care plan
contribute to the quality assessment of care provided to dying patients
support education of the multiprofessional team, enabling continued improvement to the care of dying patients.
Shortly after the introduction of the chart, a questionnaire survey of 135 healthcare professionals was conducted. This demonstrated that 97% found the chart user-friendly; 87% felt it facilitated communication between members of the multiprofessional team; 83% felt it prompted earlier intervention from doctors for symptom control; 91% felt that it improved the symptom assessment of dying patients; and 86% of nurses found it assisted them in knowing when to request additional patient review by a doctor. Finally, 87% felt it contributed to improvements in the overall care of dying patients.
The chart has also been adopted for use in the local health economy by primary care nursing teams and within care homes with nursing. Other tertiary hospitals that have embraced the chart have found it beneficial, with more detailed evaluation anticipated. Given that optimal symptom control in dying people is paramount, we believe that such a chart is of significant value in supporting the multiprofessional team to maintain a patient’s comfort and dignity.
Acknowledgements
We would like to thank the BSUH End of Life Care Steering Group, particularly Ms Karen Carroll and Dr Neha Varma who, together with the authors of this letter, devised and developed the chart; Dr Max Cooper and Dr Ambre Doherty (Brighton and Sussex Medical School) for their contribution to the chart’s evaluation.
- © 2016 Royal College of Physicians
References
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- Neuberger J.
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- Leadership Alliance for the Care of Dying People
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- Royal College of Physicians
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- National Institute for Health and Care Excellence
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