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End of life care in adults [QS13]

Measuring the use of this guidance

Statement: 1

People approaching the end of life are identified in a timely way.

Quality standard measure: Evidence of local systems in place to document identification of people approaching the end of life.
What was measured: Proportion of cases with documented evidence within the last episode of care that it was recognised that the patient would probably die in the coming hours or days.
Data collection end: May 2015
83%
Number that met the criteria: 7675 / 9302
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Evidence of local systems in place to document identification of people approaching the end of life.
What was measured: The contractor establishes and maintains a register of all patients in need of palliative care/support irrespective of age.
Data collection end: March 2015
98.5%
Area covered: England
Source: Health and Social Care Information Centre. Quality Outcomes Framework.

Quality standard measure: Evidence of local systems in place to document identification of people approaching the end of life.
What was measured: Proportion of cases with documented evidence within the last episode of care that it was recognised that the patient would probably die in the coming hours or days.
Data collection end: September 2015
93%
Area covered: England
Source: Royal College of Physicians. End of Life Care Audit – Dying in Hospital: National report for England 2016

Quality standard measure: Evidence of local systems in place to document identification of people approaching the end of life.
What was measured: PC001: The contractor establishes and maintains a register of all patients in need of palliative care/support irrespective of age.
Data collection end: March 2016
98.57%
Data collection end: March 2017
98.2%
Area covered: National
Source: Health and Social Care Information Centre. Quality and Outcomes Framework.


Statement: 2

People approaching the end of life and their families and carers are communicated with, and offered information, in an accessible and sensitive way in response to their needs and preferences.

Quality standard measure: Evidence of local availability of end of life care information in a variety of formats and languages.
What was measured: Proportion of trusts with a leaflet available outlining the changes that may occur in patients in the hours before death.
Data collection end: December 2013
90%
Number that met the criteria: 118 / 131
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Evidence of local availability of end of life care information in a variety of formats and languages.
What was measured: Proportion of trusts with a leaflet available explaining the facilities that are available for relatives and friends.
Data collection end: December 2013
60%
Number that met the criteria: 78 / 131
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Evidence of local availability of end of life care information in a variety of formats and languages.
What was measured: Proportion of trusts with a leaflet available explaining the grieving process for relatives and friends.
Data collection end: December 2013
76%
Number that met the criteria: 100 / 131
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Evidence of local availability of end of life care information in a variety of formats and languages.
What was measured: Proportion of trusts with a leaflet available explaining local procedures to be undertaken after the death of a patient.
Data collection end: December 2013
99%
Number that met the criteria: 130 / 131
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Evidence of local availability of end of life care information in a variety of formats and languages.
What was measured: Proportion of trusts with the Department for Work and Pensions leaflet 1027, What to do after a death in England and Wales or equivalent available.
Data collection end: December 2013
91%
Number that met the criteria: 119 / 131
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Evidence of local availability of end of life care information in a variety of formats and languages.
What was measured: Proportion of trusts which give a leaflet outlining the changes that may occur in patients in the hours before death (e.g. the 'Coping with dying' or' What to expect when someone important to you is dying' leaflets or equivalent) to families and those people who are important to the patient.
Data collection end: July 2015
78%
Number that met the criteria: 111 / 142
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Evidence of local availability of end of life care information in a variety of formats and languages.
What was measured: Proportion of trusts which give a leaflet which explains local procedures to be undertaken after the death of a patient, to families and those people who are important to the patient.
Data collection end: July 2015
97%
Number that met the criteria: 138 / 142
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Evidence of local availability of end of life care information in a variety of formats and languages.
What was measured: Proportion of trusts which give the Department for Work and Pensions leaflet 1027, What to do after a death in England and Wales or equivalent, to families and those people who are important to the patient.
Data collection end: July 2015
90%
Number that met the criteria: 128 / 142
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Evidence of local arrangements for the use of suitable environments to ensure sensitive communication about end of life care.
What was measured: Proportion of trusts with designated ‘quiet spaces’ available for relatives or carers up to, including and after the death of the patient.
Data collection end: July 2015
75%
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Evidence that local service user feedback relating to end of life care, in the form of surveys, compliments and complaints, is collected, analysed and acted upon.
What was measured: Proportion of trusts which sought bereaved relatives’ or friends’ views during the last two financial years.
Data collection end: July 2015
80%
Number that met the criteria: 114 / 142
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Evidence that local service user feedback relating to end of life care, in the form of surveys, compliments and complaints, is collected, analysed and acted upon.
What was measured: Proportion of trusts which sought bereaved relatives' or friends' views during the last two financial years and implemented change to their service as a result of their most recent assessment.
Data collection end: July 2015
67%
Number that met the criteria: 76 / 114
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Evidence that local service user feedback relating to end of life care, in the form of surveys, compliments and complaints, is collected, analysed and acted upon.
What was measured: Proportion of Trusts with a mechanism for flagging complaints that related to end of life care.
Data collection end: July 2015
78%
Number that met the criteria: 111 / 142
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Proportion of people identified as approaching the end of life who are offered information appropriate to their circumstances.
What was measured: Proportion of people who were recognised as being likely to die had documented evidence of a discussion with a healthcare professional about their likely imminent death.
Data collection end: September 2015
25%
Area covered: England
Source: Royal College of Physicians. End of Life Care Audit – Dying in Hospital: National report for England 2016


Statement: 3

People approaching the end of life are offered comprehensive holistic assessments in response to their changing needs and preferences, with the opportunity to discuss, develop and review a personalised care plan for current and future support and treatment.

Quality standard measure: Proportion of people identified as approaching the end of life whose records include a documented assessment and discussion of their physical, psychological, social, spiritual and cultural needs and preferences.
What was measured: Proportion of cases with documented evidence within the last episode of care of discussion regarding the patient's spiritual/cultural/religious/practical needs with the patient or the nominated person important to the patient as a proxy for the patient.
Data collection end: May 2015
42%
Number that met the criteria: 3886 / 9302
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Proportion of people identified as approaching the end of life whose records include a documented assessment and discussion of their physical, psychological, social, spiritual and cultural needs and preferences.
What was measured: Proportion of cases with documented evidence in the last 24 hours of life of a holistic assessment of the patient’s needs regarding an individual plan of care.
Data collection end: May 2015
66%
Number that met the criteria: 6125 / 9302
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: People approaching the end of life and their families and carers feel that the assessment process was a useful means to considering their needs and preferences, identifying next steps and securing appropriate services.
What was measured: Proportion of cases, with documented evidence within the last episode of care of discussion regarding the patient's spiritual/cultural/religious/practical needs, where the identified needs were met.
Data collection end: May 2015
89%
Number that met the criteria: 3450 / 3886
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.


Statement: 6

People approaching the end of life are offered spiritual and religious support appropriate to their needs and preferences.

Quality standard measure: Proportion of people identified as approaching the end of life who receive spiritual and religious support in accordance with their care plan.
What was measured: Proportion of capable patients who had a discussion regarding their spiritual needs.
Data collection end: December 2013
21%
Number that met the criteria: 715 / 6576
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Proportion of people identified as approaching the end of life who receive spiritual and religious support in accordance with their care plan.
What was measured: Proportion of patients nominated relatives/friends whom had a discussion regarding the patients spiritual needs
Data collection end: December 2013
23%
Number that met the criteria: 1342 / 5862
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Proportion of people identified as approaching the end of life who receive spiritual and religious support in accordance with their care plan.
What was measured: Proportion of cases with documented evidence within the last episode of care of discussion regarding the patient’s spiritual/religious/cultural /practical needs with nominated person(s) important to the patient.
Data collection end: May 2015
38%
Number that met the criteria: 3519 / 9203
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Proportion of people identified as approaching the end of life who receive spiritual and religious support in accordance with their care plan.
What was measured: Proportion of capable patients who had a documented discussion during the last episode of care regarding their spiritual needs.
Data collection end: September 2015
15%
Area covered: England
Source: Royal College of Physicians. End of Life Care Audit – Dying in Hospital: National report for England 2016

Quality standard measure: Proportion of people identified as approaching the end of life who receive spiritual and religious support in accordance with their care plan.
What was measured: Proportion of patients nominated relatives/friends whom had a discussion regarding the patients spiritual needs
Data collection end: September 2015
27%
Area covered: England
Source: Royal College of Physicians. End of Life Care Audit – Dying in Hospital: National report for England 2016

Quality standard measure: Evidence of local access to a range of spiritual care providers for people approaching the end of life, either in-house or through referral to appropriate providers in the community.
What was measured: Proportion of trusts with guidelines for referral to ‘Pastoral care/Chaplaincy Team’.
Data collection end: July 2015
77%
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.


Statement: 7

Families and carers of people approaching the end of life are offered comprehensive holistic assessments in response to their changing needs and preferences, and holistic support appropriate to their current needs and preferences.

Quality standard measure: Carers and families of people approaching the end of life feel supported.
What was measured: Proportion of bereaved relatives who felt adequately supported during the last 2 days of life.
Data collection end: December 2013
76%
Number that met the criteria: 610 / 802
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Evidence of local arrangements to ensure that families and carers of people approaching the end of life are offered holistic support appropriate to their own current needs and preferences.
What was measured: Proportion of Trusts with hospital chaplaincy team/support or multi denominational spiritual/religious support available to people important to the dying patient.
Data collection end: July 2015
99%
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Evidence of local arrangements to ensure that families and carers of people approaching the end of life are offered holistic support appropriate to their own current needs and preferences.
What was measured: Proportion of Trusts with specialist palliative care team available to people important to the dying patient.
Data collection end: July 2015
98%
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Evidence of local arrangements to ensure that families and carers of people approaching the end of life are offered holistic support appropriate to their own current needs and preferences.
What was measured: Proportion of Trusts with Macmillan / Marie Curie Palliative Care Clinical Nurse Specialist or information available to people important to the dying patient.
Data collection end: July 2015
96%
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Evidence of local arrangements to ensure that families and carers of people approaching the end of life are offered holistic support appropriate to their own current needs and preferences.
What was measured: Proportion of Trust with specialist or lead nurses (EOL and other specialties) available to people important to the dying patient.
Data collection end: July 2015
88%
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Evidence of local arrangements to ensure that families and carers of people approaching the end of life are offered holistic support appropriate to their own current needs and preferences.
What was measured: Proportion of Trusts with access to bereavement services/bereavement team available to people important to the dying patient.
Data collection end: July 2015
79%
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Evidence of local arrangements to ensure that families and carers of people approaching the end of life are offered holistic support appropriate to their own current needs and preferences.
What was measured: Proportion of Trusts with hospice services support available to people important to the dying patient.
Data collection end: July 2015
78%
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Evidence of local arrangements to ensure that families and carers of people approaching the end of life are offered holistic support appropriate to their own current needs and preferences.
What was measured: Proportion of Trusts with overnight stay facilities available to people important to the dying patient.
Data collection end: July 2015
77%
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Evidence of local arrangements to ensure that families and carers of people approaching the end of life are offered holistic support appropriate to their own current needs and preferences.
What was measured: Proportion of Trusts with access to counselling services available to people important to the dying patient.
Data collection end: July 2015
60%
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Evidence of local arrangements to ensure that families and carers of people approaching the end of life are offered holistic support appropriate to their own current needs and preferences.
What was measured: Proportion of Trusts with psychologist (adult and/or child) support available to people important to the dying patient.
Data collection end: July 2015
58%
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Evidence of local arrangements to ensure that families and carers of people approaching the end of life are offered holistic support appropriate to their own current needs and preferences.
What was measured: Proportion of Trusts with complementary therapy available to people important to the dying patient.
Data collection end: July 2015
31%
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Proportion of nominated informal carers (such as a family member) of people identified as approaching the end of life, who receive holistic support in accordance with their most recent assessment.
What was measured: Proportion of cases with documented evidence of care and support of the patient's family and those important to them at the time of and immediately after death.
Data collection end: May 2015
64%
Number that met the criteria: 5944 / 9302
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Proportion of nominated informal carers (such as a family member) of people identified as approaching the end of life, who receive holistic support in accordance with their most recent assessment.
What was measured: Proportion of cases with documented evidence of person(s) important to the patient being asked about and identifying their needs, and those needs being addressed successfully.
Data collection end: May 2015
73%
Number that met the criteria: 2274 / 3128
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Proportion of nominated informal carers (such as a family member) of people identified as approaching the end of life, who receive a comprehensive and holistic assessment of their own needs and preferences.
What was measured: Proportion of people identified as person(s) important to the patient whose needs were asked about.
Data collection end: September 2015
54%
Area covered: England
Source: Royal College of Physicians. End of Life Care Audit – Dying in Hospital: National report for England 2016

Quality standard measure: Proportion of nominated informal carers (such as a family member) of people identified as approaching the end of life, who receive a comprehensive and holistic assessment of their own needs and preferences.
What was measured: Proportion of people identified as person(s) important to the patient who were doumented as receiving support at the time of and immediately after death.
Data collection end: September 2015
65%
Area covered: England
Source: Royal College of Physicians. End of Life Care Audit – Dying in Hospital: National report for England 2016


Statement: 15

Health and social care workers have the knowledge, skills and attitudes necessary to be competent to provide high-quality care and support for people approaching the end of life and their families and carers.

Quality standard measure: Evidence of local arrangements to ensure that health and social care workers receive training appropriate to their role incorporating dealing with loss, grief and bereavement, and basic aspects of spiritual care, common to people of all faiths and none.
What was measured: Proportion of trusts reported having a formal in-house continuing education programme on the subject of care of the dying.
Data collection end: December 2013
82%
Number that met the criteria: 108 / 131
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.

Quality standard measure: Evidence of local arrangements to ensure that health and social care workers receive training appropriate to their role incorporating dealing with loss, grief and bereavement, and basic aspects of spiritual care, common to people of all faiths and none.
What was measured: Proportion of trusts reporting having a formal in-house continuing education programme on the subject of end of life care.
Data collection end: July 2015
96%
Number that met the criteria: 136 / 142
Area covered: National
Source: Royal College of Physicians. National Care of the Dying Audit for hospitals, England.



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