Title : Live well die gently
Abstract:
I n 2013 the author commissioned a piece of work to audit 320 deaths over a 6 month period 1st April 2013 – 31st September 2013 in adults only, from a population of 100,000 patients. Deducting the sudden/unexpected deaths left 231 records to be audited. The findings were disappointing and revealed inconsistencies in care, treatment and understanding.We found patients were left little choice in where they chose to pass away with no provision of hospice beds, voluntary sector provision was negligible and patients were not being identified early enough to support them and their families. Respondents to the national 2014 VOICES survey reported that more than 82% of people would prefer to die at home, with 8% preferring to die in a hospice, 6% in a care home, 3% in a hospital and 1% somewhere else. However, individual preferences change as death approaches, with fewer individuals wanting to die at home and more wanting to die in a hospice. For our population (100,000) the audit of deaths revealed that patients had died in the following areas: 41% had died in hospital, 49% in home/usual place of residence, 8% in a hospice/community hospital and 2% no place recorded. In 2014 the author was awarded a Florence Nightingale Scholarship to travel to the USA and in 2015 a Winston Churchill Fellowship to travel to New Zealand. Both tours were to visit centers of best practice in palliative and End of Life Care and share the learning and networks back in the UK. In September 2015 the organization was awarded funding from the Macmillan Cancer Trust to be applied to a project for the scoping and review of End of Life Services across the same 100,000 population, including support to the implementation of key actions and outcomes. The project has focused on end of life care, i.e. care provided in the last phase of life (usually 12 months), as opposed to the broader palliative care (supporting a person with a serious illness for which there is no potential cure). Identifying that someone is entering the last year of their life not only benefits the individual, to enable provision of supportive care that meets their needs and wishes, but can also reduce the burden on the health and social care system through the commissioning of more effective services. A further audit of deaths over a 6 month period was done (July 15th – December 15th) looking at 206 expected deaths for the same 100,000 population to compare practices and see if there were any variations. This revealed that without any actions or interventions the results were nearly identical 40% had died in hospital, 48% in home/usual place of residence, 8% in a hospice/community hospital and 4% no place recorded. Changing the way we care in the last 12 months of someone’s life has an everlasting effect for the families and loved ones. The project has considered practices from around the world looking at living wills, starting the conversation, identifying our 1% earlier, awareness raising, and consideration of choices. This presentation will share the learning from the authors gained experiences.
Audience Take Away:
• The audience will hear about the benefits of examining and visiting centres of best practice from around the world.
• The audience will hear how several centres of best practice around the world deliver innovative practice for end of life care.
• The audience will be given real examples of changes made and how these can be delivered in other centres.
