Digitally Recording Comfort Observations in the Last Days of Life

Author:

Stewart Eleanor1ORCID,Ford-Dunn Suzanne2,Bass Steve1ORCID,Ede Charlotte2,Elliott Julie2,Peters Debbie2,Caputo Rita2,Moreira Luis2,Savage Emily3,Minton Ollie23ORCID

Affiliation:

1. Department of Palliative Medicine, University Hospitals Sussex NHS Foundation Trust, Brighton, UK

2. Department of Pallaitive Medicine, University Hospitals Sussex NHS Foundation Trust, Worthing, UK

3. Department of Palliative Care, Royal Sussex County Hospital, Brighton, UK

Abstract

Background: 37.5% of deaths in our area occur in hospital. There are known high unmet needs of adult patients dying in hospital, this unmet need can be reduced by using an individualised care plan and specialist palliative care review. Intervention: In 2022 UHSussex developed an electronic comfort observation chart and individualised care plan, with a centralised dashboard allowing Palliative Care Teams (SPCT) to view trends, target interventions, and a rolling prospective audit. Results: 3000 patients have had their care supported with electronic comfort observations (e-comfort obs). Over 72% of all deaths in the Trust in the last 3 months have been on e-comfort obs, with 2/3 of all deaths in the first 12 months on e-comfort obs. The average length of time on e-comfort obs is 4 days resulting in 70,000 sets of e-comfort obs recorded since launch. Seven percent of e-comfort obs record moderate or severe symptoms. We have identified benefits to people who are dying, those important to them, ward staff, SPCT and on a systems level. Conclusion: E-comfort obs can be successfully embedded in a large acute Trust. This development should improve quality of end of life care in our hospitals both for individuals and for future patients, through on-going targeted education and intervention. Further work is needed to develop the system further including integrating data from electronic prescribing.

Publisher

SAGE Publications

Reference11 articles.

1. Office for Health Improvement and Disparities. Palliative and end of life care factsheet: recent trends in place of death NHS sussex integrated care board October 2023. Available: fingertips.phe.org.uk/static-reports/end-of-life-place-of-death/October_2023/nE54000053.html?area-name=NHS_Sussex_Integrated_Care_Board-QNX. Accessed November 16, 23.

2. University CQC. Hospitals Sussex NHS foundation trust all inspections. Webpage Available: www.cqc.org.uk/provider/RYR. Accessed November 16, 23.

3. Seeking Excellence in End of Life Care UK (SEECare UK): a UK multi-centred service evaluation

4. Neuberger J, Guthrie C, Aaronovitch D, et al. More care, less pathway a review of the Liverpool care pathway. 2013. Available: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/212450/Liverpool_Care_Pathway.pdf. Accessed November 16, 23.

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