Heartbeat: Identifying patients with a short prognosis
March 11, 2022
At SWB we use the end-of-life dashboard, a platform for collating information, stats and feedback relevant to the end-of-life care delivered on a particular ward.
We caught up with Dr Hannah Mottershead, Elderly Care Consultant who told us more about how the dashboard is used to plan the care of some of our patients.
She said: “The dashboard is very useful for looking at whether your ward is meeting end-of-life quality care indicators, establishing whether performance is improving over time and for easily identifying which aspects of end-of-life care require more attention than others.
“As a summary you can also look at the data and ask yourself – does this match my perceptions as to how we are doing? If it doesn’t, this is a great triggering question for asking yourself why. Perhaps our documentation isn’t truly matching our actions, perhaps we aren’t recognising early enough that people are in the last phase of their life? How can we improve these things? Also, you can look to see how different areas are working – maybe a different ward has some great lessons that they could help us with so that we can improve too.”
Hannah went on to explain the challenges of having end of life discussions with patients and families.
“These conversations are challenging, no one will ever argue with that, but that doesn’t mean we should be put off from having them. If a patient chooses not to discuss it then that is their choice and should be respected, but that is different from not being given the opportunity to talk about it.
“The frail elderly patients I see are rarely shocked that I think they might be dying – they think that themselves and are often relieved that they get to talk about it and tell us what they want. Mostly I feel that I am able to provide reassurance that help is available rather than worsening fear. Not talking about the inevitable (and often clinically obvious) development of events towards the end of life, can increase a patient’s fear.
“End-of-life care can be physically and emotionally draining and some colleagues have a natural ability to have more difficult conversations and to recognise that a patient is end-of-life. They have had clinical, and probably personal, experiences that have equipped them with the expertise they need to deal with caring for the dying in an empathetic and holistic way.
“I believe that our staff want to provide patients with the best end-of-life possible, even when they are struggling to do so. Skills can be improved with training, cycles of quality improvement projects, continued campaigns to increase awareness, championing the topic and rolemodelling quality care. The end-of-life quality improvement project is looking at all of these issues realistically, that’s what is going to make it a success.”
Hannah also shared her top tips.
“I would suggest being open minded to the possibility that patients are within the last year of their life. Ask yourself the question, use the SPICT tool, which is now embedded within Unity, and ask for help. Don’t be afraid to gather the opinions of your juniors, your nurses and your wider MDT. Maybe they have seen something that you have not. Look at the dashboard, get training.
“I could go on about top tips for years. Better than all of this, if you are not recognising that people are dying, if you don’t feel comfortable having these conversations, if you find yourself questioned on end-of-life care regularly, please don’t get frustrated and downhearted, but please do take the time to question why. There is training and help available.”