128 Challenging locational boundaries in the treatment of palliative care emergencies

<h3>Background</h3> Compton Care’s clinical strategy (2022 - 2025) identifies the need for responsive services to prevent crisis escalation, avoid hospital admissions and support hospital discharges. Our community Rapid Response service leads on individualised specialist end of life care for patients in the last days to weeks of life. Our virtual ward model has been supporting patients since April 2023 to be cared for in the place they call home and avoid unwanted admissions to hospital. During this time it has become apparent that some patients require treatments to palliate symptoms that were previously only available in an acute hospital or inpatient hospice setting. The virtual ward model has allowed the development of personalised treatment plans to enable patients to have this level of care at home. <h3>Aim</h3> To analyse the interventions delivered within a Virtual Ward model, aimed at preventing unnecessary hospital admissions. <h3>Methods</h3> We collated and analysed data from patients known to the Virtual Ward who received interventions within their own home. <h3>Results</h3> Of the 8 patients that received interventions for palliative care emergencies arising in the home, 3 were female and 5 male. All but 1 patient had a ReSPECT Plan prior to the intervention identifying preferred place of care/death (PPC/D) as home. The conditions requiring treatment were hypercalcaemia of malignancy, status epilepticus, sepsis, complex gastrointestinal secretion management and complex seizure management. 100% of patients avoided hospital admissions and 1 prearranged elective admission for specific intervention with rapid discharge home was arranged. All patients died in their PPC/D. Interventions delivered included: IV bisphosphonate; subcutaneous (SC) fluids; SC Levetiracetam loading infusion and SC phenobarbital. <h3>Conclusions</h3> The development of virtual ward and implementation of personalised treatment plans has allowed complex symptom management within the community and we have been able to accommodate patient choice on preference of location for treatment.