Dr. Hugh Klim

East Kent University Hospitals Foundation Trust, United Kingdom

Title: A quality improvement project in treatment escalation planning in an English hospital

Abstract

Introduction: It has been shown that a Treatment Escalation Plan (TEP) in addition to a standard DNACPR order is associated with a reduced frequency of harms especially in patients judged to be nearing the end of life, compared to using a DNACPR alone.1

Therefore, I proposed a Quality Improvement Project based on assessing how many patients in a set group answered the following questions:

1. Does the patient have a DNACPR form?

2. Does the patient have a completed TEP form?

3. On a completed TEP, were these wishes clear and appropriate for clinical scenarios the patient is likely to encounter?

4. Was the TEP discussed in agreement with that Patient & Next of Kin (NOK)?

5. Is the Multi-Disciplinary Team (MDT) in agreement with the plan?

Methods: To obtain my data, I reviewed the notes of 94 patients over four weeks between September and October 2021 on two Geriatric Wards at the William Harvey Hospital in Kent.

For Question 1, 54 out of 94 patients had a completed DNACPR forms.

For Question 2, 15 out of these 54 patients had completed TEP forms. This was 28%.

For Question 3, 12 out of 15 TEP forms had expressed clear wishes for clinical scenarios. This is 80%.

For Question 4, 7 out of 15 TEP forms had been discussed with NOK. This was 46%.

For Question 5, 6 out of 15 TEP forms had evidence of MDT involvement. This was 40%.

Conclusion: My recommendations were:

- At Geriatric Ward admission, a TEP should be regularly completed and involve the entire MDT input and NOK, with their input recorded clearly.

- At Hospital Admission, an electronic prompt to the Consultant’s First Review may provide a way to get more TEP forms completed for more patients quickly, safely and with senior supervision.

Biography

Hugh Klim is a medical doctor in the United Kingdom, who completed his medical degree in 2020 and has a firm interest in Palliative Care

2nd International Conference on Palliative Care and Hospice Nursing

Dr. Hugh Klim

Title: A quality improvement project in treatment escalation planning in an English hospital

Abstract

Biography

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