The acute health service:
- includes the quality of end of life care in processes of clinical governance
- shares information with staff.
Methods of evaluation and audit may include:
- Palliative Care Experience Survey for patients and carers (due 2017–2018)
- morbidity and mortality review for comprehensive assessment of end of life care
- mechanisms for:
- auditing the presence of a current advance care plan, limitations of medical treatment (resuscitation plan) and goals of care
- auditing deaths of patients without a Care Plan for the Dying Person – Victoria (or equivalent)
- reviewing the quality of deaths
- projects conducted by medical or health information trainees as part of their training.
The mortality review should:
- be interdisciplinary, collaborative, and problem-solving
- be integrated into established processes
- include those who had the most contact with the patient, including the general practitioner if involved in inpatient care
- ask what went well, what didn’t go so well, and what could have been done differently to improve the quality of care for the patient and family
- disseminate findings and actions to all staff.
The mortality review should include the following measures:
- Congruence of goals of care with clinical decision making. For example, the clinician with overall responsibility for coordinating the patient’s care was identified; complexity and conflict were appropriately managed; the palliative care consultancy service was involved if appropriate; other disciplines, such as pastoral care, occupational therapy or pharmacy, were involved if appropriate.
- The presence of an advance care plan congruent with the patient’s wishes for elements such as sites of care and death and identification of the substitute decision maker. Reasons for not achieving the patient’s wishes should be identified and reviewed.
- Limitations of medical treatment (resuscitation plan) were congruent with clinical decision making.
- Timely recognition of deterioration and dying and the appropriateness of clinical management (what could we have done to reduce the patient’s and family’s suffering?).
- Care Plan for the Dying Person – Victoria (or equivalent) was activated at the appropriate time.
- Identification of carers and family members with complex bereavement needs and activation of appropriate supports.
- Identification of staff members in need of assistance and activation of appropriate supports.