Audit raises concern about care of dying patients in Brighton and Hove
A national audit of the care given to dying patients has highlighted shortcomings in Brighton and Hove.
It found that too few people had access to specialist support for care in the last hours or days of their life.
And it questioned whether they were being given the right level of foods, fluids and medicine.
Bereaved family members and friends were not being offered formal ways to give feedback about the care given to their loved ones.
The clinical audit also found that Brighton and Sussex University Hospitals NHS Trust fell short in its board-level representation and planning for the care of the dying.
As an organisation, the trust, which runs the Royal Sussex County Hospital in Kemp Town, achieved four out of the seven key performance indicators (KPIs) in the audit.
The results were published in the National Care of the Dying Audit of Hospitals today (Thursday 15 May) by the Royal College of Physicians and the Marie Curie Palliative Care Institute Liverpool.
It scored better for
- access to information about death and dying
- clinical protocols for prescribing medication for the five key symptoms at the end of life, including pain, agitation, difficulty breathing and nausea or vomiting
- clinical provision and protocols for promoting patient privacy, dignity and respect up to and after death
As well as the seven organisational KPIs, the audit also looked at clinical KPIs.
The lowest scores were for reviews of dying people’s nutritional and hydration requirements, their treatment – or interventions by doctors and nurses – and multi-disciplinary recognition that a patient was dying.
The Brighton trust also scored poorly for reviewing, after a patient’s death, the care that he or she had been given.
The trust scored better for communication, prescribing medicine for the key symptoms at the end of life and the number of assessments carried out in a patient’s final 24 hours.
Some of the shortcomings relate to issues that have been the subject of recommendations over the past ten years.
And more recently criticisms have been made about the use of a method of managing a patient’s death known as the Liverpool Care Pathway. It may involve the withdrawal of food, fluids and medicine.
The review team’s report said: “The audit shows that major improvements need to be made to ensure better care for dying people and better support for their families, carers, friends and those important to them.”
The review relied on case notes as researchers looked at the care given in 149 hospitals to more than 6,500 people out of more than 500,000 who died last year. One person in two dies in hospital. All the patients whose notes were reviewed died in May last year.
The researchers also asked more than 800 bereaved family members for their views.
Each of the KPIs for the Brighton trust was based on information about 45 to 50 patients, all of whose deaths were expected.
The review was funded by the Marie Curie Cancer Care charity and Public Health England.
