An Opportunity to Press the “Pause” Button

Dr Kathleen McLoughlin

National Audit and Review Co-ordinator (End of Life)

Why do we need to audit and review end of life care?

Institutionalisation of End of Life Care in Western Society

Place of Death in Ireland (2010)

Remember ‘The Wish’?

“Caring for older people and those approaching the end of

their lives is rightly said to be a litmus test for health and social care and indeed a measure of our whole society…As well as more effective

inspections of hospitals, greater scrutiny and clearly understood standards about patient safety, treatment and care, staff at all levels

must feel able to voice their concerns with confidence that senior managers will take these seriously and act upon them. This requires a

new approach...including…core training in caring for people approaching the end of their life, and embedding measures of patient

experience throughout all health and care settings.”

Eve Richardson Chief Executive of the National Council for Palliative Care and the Dying Matters Coalition

Feb 2013 in response to the Francis Report

What do we know already?

There is lack of agreement…

The Pilot System

• Audit is now becoming central feature of the healthcare system in Ireland

• Purpose: to support a process of continuous improvement in the care of persons at the end of life from the perspective of staff and relatives/friends

• Applicable to all adult deaths regardless of diagnosis or whether the death was sudden/expected

• For expected deaths the focus is on the care provided during the last week of the deceased person’s life

• Designed to review deaths in all care settings

• Builds on the National Audit 2008/9 and is underpinned by the Quality Standards for End-of-Life Care & Standard 16

• Developed in partnership with HSE Quality, Safety & Risk Directorate and the HSE Clinical Strategy & Programme Directorate

• Consultation took place with HIQA, HSE Palliative Care Working Group, HQIP (UK) Help the Hospices (UK)

Components of the System

1. Audit tool for use in staff meeting

2. Bereaved relatives/friends questionnaire

3. Quality improvement questionnaire

For the pilot phase a 4th component will be included:

4. Independent assessment of the usefulness of the audit tool by audit manager

All components are aligned to the domains of care

Cognitive testing

Aims and Objectives • To support a process of continuous improvement in the care of persons at the end

of life, including their families. This will be achieved through the following objectives: • To facilitate staff to review and reflect on the structures, processes and outcomes

of end of life care provided. • To carry out an independent assessment of the audit tool for staff with a view to

establishing its validity and reliability. • To survey bereaved relatives to determine their perspective on the experience of

the patient’s care in the last week of life. • To observe how audit meetings are held and facilitated to assess support that

facilitators may require to ensure that these meetings are inclusive, constructive, and capable of bringing about improvements in care as required.

• To document the quality improvements that have taken place at each site as a result of the audit.

• To build a national database on end of life care which (1) assists each site and setting to review its care; (2) gives a national overview of the quality of care provided to persons during the last week of life; (3) facilitates further research and development on the audit system.

• To prepare regular reports on the quality of end of life care with a view to promoting continuous improvement.

Progress to Date

Progress to Date

But it’s more than numbers…

• Staff support

• Improved communication

• Quality improvement plans

• Training needs analysis

The Future…

• Site reports

• Workshop (Monday)

• Pilot report (End April)

• Modification

• Roll Out Nationally

Acknowledgments

• Dr Kieran McKeown • Mary Bowen Who developed the system prior to its pilot implementation nationally. • Grace O’Sullivan • Jackie Crinion Thank you Kathy.mcloughlin@hospicefoundation.ie 0894667915