The GSF team would welcome information about examples of audits which have led to improvement in end of life care. Examples may relate to any aspect of end of life care including care prior to hospital discharge or use of the end of life care pathway in the community.
The following audits are suggested for general practices who have moved beyond the foundation level of GSF.
The first step to providing good care is to identify patients in the last year of life. To allow time for advance care planning and for all the components of a care plan to be put in place it is recommended that patients are identified up to a year prior to death. Clearly this is not always possible.
| Two reflective audits are recommended to improve identification: |
- Looking at all deaths not on the register to consider whether, with the benefit of hindsight, it could have been recognised that the person had end of life care needs. As an initial guide for a general practice, at least 20% of all patients who die should have been on the palliative care register. Additionally where a person dies who was on the register the team could reflect on whether they were identified at the earliest/best time.
- For general practices it is recommended that they look at the percentage of patients on their palliative care register who have a non-malignant diagnosis. Cancer patients have traditionally been recognised as having end of life care needs. This is a new way of thinking for other diagnoses such as heart failure, COPD, frailty and those with multiple morbidities. As an initial step the percentage should be at least 20%. However, statistics show that only 25% of deaths are due to cancer and that only 10% are sudden unpredictable deaths. We would therefore expect the percentage of patients on the palliative care register with non-malignant conditions to rise within the next few years. This will be informed by both QOF data and the national primary care audit of end of life care due to report later this year.
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