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Audit praises standards of palliative care

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Hospitals have been praised for providing good standards of palliative care to dying patients, but researchers have made a series of recommendations for improvements.

An audit led by the Marie Curie Palliative Care Institute Liverpool, together with the Royal College of Physicians, looked at statistics on more than 7,000 patients at 127 NHS trusts who received help from by the Liverpool Care Pathway for the Dying Patient (LCP).

A total of 131 trusts in England gave researchers data on patients in the last hours or days of life, which was also analysed for the audit.

After looking at eight areas of care provision and delivery, the audit, which was supported by the charity Marie Curie Cancer Care and the Department of Health End of Life Care Programme, praised the high standards of care provided in general within hospitals.

But it did raise fears that specialist palliative care teams lack access to support services and warned training and education for healthcare staff looking after dying patients could be improved.

Among its recommendations was a suggestions that staff caring for patients at the end of their life should receive compulsory training in that field.

They also said that healthcare professionals caring for dying patients should have access to specialist palliative care teams in hospitals seven days a week from 9am to 5pm.

In addition, to help with training, education and the filling in of documents, all hospitals should have an LCP facilitator.

The audit recommended the multidisciplinary/multiprofessional team should be responsible for the decision that a patient is in the last days or hours of their life. The senior doctor looking after the patient should then document that decision. Where possible, patients should be consulted about such a decision. Families and other carers must also be included in discussions and there should be suitable written guidance to help with such conversations.

When the patient is nearing the end of their life, their condition should be checked regularly and noted down on paper every four hours, the researchers said. At least once every three days, a full review by the multidisciplinary/multiprofessional team should be carried out.

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