New research published this month states the inclusion of the Liverpool developed post-bereavement survey to the National Care of the Dying Audit could be a valuable way for hospitals to improve care.
The National Care of the Dying Audit – Hospitals (NCDAH) is a report produced by the Royal College of Physicians which shows need to improve care for people dying in hospitals. It states hospitals should provide a face-to-face specialist palliative care service from at least 9am to 5pm, 7 days per week, to support the care of dying patients and their families, carers or advocates.
The report evaluates the quality of care provided to dying patients and their families in acute hospitals, from the perspective of bereaved relatives.
The ‘Care Of the Dying Evaluation’ (CODE) questionnaire was first developed in 2011 by Dr Catriona Mayland, Honorary Senior Clinical Lecturer at the Marie Curie Palliative Care Institute Liverpool (MCPCIL), University of Liverpool and Consultant in Palliative Medicine at the Royal Liverpool and Broadgreen University Hospitals NHS Trust. The questionnaire was added as an additional component to the 2013/2014 NCDAH.
Better care
The research, which has been published by BMJ Supportive and Palliative Care, shows the NCDAH found significant variations in care across hospitals in England and that major improvements need to be made to ensure better care for dying people, and better support for their families, carers, friends and those important to them.
858 bereaved relatives returned a completed CODE questionnaire.
On the whole, the majority of participants reported good or excellent care, with patients’ symptoms generally perceived to be well controlled and 769 (91%) of participants reporting that either no pain was present or only there ‘some of the time.
However, a small but significant minority perceived poor quality of patient care.
Valuable addition
Clear and timely communication was identified as an urgent issue to be addressed, with unmet information needs being a recognised area for improvement, for example, 230 (29%) reporting that having a discussion about hydration would have been beneficial.
The research paper concludes that adopting a post-bereavement survey appears to be a feasible, acceptable and valuable addition to the national audit.
Dr Catriona Mayland, said, “CODE helps us understand the real experiences of bereaved relatives and their loved ones and identify areas that would improve the experience of care for the dying.
This is a significant and helpful addition to an audit of patient documentation for care for the dying, which if continued can make a real contribution to improving quality of care.”
Sustained difference
Dr Catriona Mayland and Dr Stephen Mason from MCPCIL have recently been awarded a Wellcome Trust Public Engagement Grant to support public engagement events to further develop CODE.
MCPCIL was formed in 2004 and is a partnership between the University of Liverpool, Marie Curie Cancer Care, and the Royal Liverpool and Broadgreen University Hospitals NHS Trust. The Institute aims to make a real and sustained difference to care at the end of life from bedside to policy, through service innovation and improvement, research and development, and knowledge transfer to inform clinical excellence.
The paper, entitled ‘How well do we currently care for our dying patients in acute hospitals: the views of the bereaved relatives?’, can be accessed online here.