National Care of the Dying Audit - Hospitals (NCADH)
One way of evaluating the level of care provided for patients dying on an LCP in our acute hospital trusts in the UK is to engage in a national audit project against which future provision of care could be measured.
Round 1 of the audit- 2006/2007
Conducting the audit
One hundred and eighteen hospitals took part in the first round in 2006/2007 submitting data from 2672 patients whose care in the final days of life was driven by the LCP. The audit provided individual hospitals with useful comparative information on the delivery of care in the last days of life and illustrated examples of excellence across the board.
Results of audit
Overall, the generic audit results revealed that while standards of clinical care for the individual patient were high, there was room for improvement in the assessment of insight and spiritual needs, particularly those of patients. In general, communication with patients and primary care and information sharing both before and after the death of the patient remains a challenge.
- Generic full report (pdf, 72 pages)
- Summary Report (pdf, 20 pages)
Using the results
Following the dissemination of the results, three regional workshops, attended by around 120 participants, were held to provide a forum for further discussion and action-planning for future improvement. An overwhelming majority of participants felt that the workshops had provided a valuable opportunity to network and share good practice and that participation in the audit would lead to improvements in care of the dying in their hospitals.
- View the summary report (pdf) of the workshops conducted.
Participants in the first round of the audit were invited to submit examples of good practice from their hospitals regarding improving the quality of care delivery to dying patients and their families.
Round 2 of the audit - 2008/2009
The second round of the National Care of the Dying Audit Hospitals, co-ordinated by the Marie Curie Palliative Care Institute Liverpool (MCPCIL) in collaboration with the Royal College of Physicians (RCP) is currently underway.
One hundred and fifty-five hospitals from within115 acute hospital trusts in England provided a total of 3893 individual datasets for patients who were cared for in the final days and hours of life using the Liverpool Care Pathway for the Dying Patient (LCP). This represents a 32% increase on the number of hospitals that took part in round 1 and 104 hospitals participated in both rounds. Round 2 also includes a pilot cohort of 13 hospitals from 5 Trusts in Northern Ireland.
New this round, alongside data from the goals of care on the LCP, information on the prescription and administration of medications for agitation and restlessness in the last 24 hours of life will be reported, as well as data recorded on the variance sheets for a selection of goals. Data analysis is now nearing completion and the reports are currently under construction. We plan to make individual hospital reports available to participating hospitals in the summer of 2009.
These reports will allow hospitals to benchmark their relative performance on key domains of care (physical, psychosocial and spiritual, communication, information and adherence to policies and procedures) and to make comparisons with their performance in the previous rounds where appropriate. Once again, we plan to undertake regional workshops in Liverpool, London and this time in Belfast in September and October of 2009 to allow participants to debate the findings and action plan for improvements in future care. The results will allow hospitals to benchmark their relative performance on key domains of care (physical, psychosocial and spiritual, communication, information and adherence to policies and procedures).
Regional workshops will be undertaken in the autumn of 2009 to allow participants to debate the findings and action plan for improvements in future care. Importantly, the results from this round of the audit will also be used to inform the development of Version 12 of the LCP which will be launched towards the end of 2009.
Results of the Audit
The second round of the National Care of the Dying Audit of Hospitals (NCDAH) shows that the majority of patients on the Liverpool Care Pathway for the Dying Patient (LCP) are receiving high quality care in the last hours and days of life. Read the accompanying press release about the National Audit. Copies of LCP documentation can be accessed here.
