52 Are comfort observations improving patient care? A retrospective audit across Manchester foundation trust

<h3>Background</h3> Comfort observations offer an alternative to routine clinical observations with a focus on comfort and symptom control in patients approaching the end of their life. These observations include pain assessment, mouth care and respiratory efforts instead of measures of physiological function. This audit aimed to determine whether comfort observations impact on patient care, such as prompting PRN medication usage or clinical review. It was carried out in one hospital initially before being expanded to the rest of Manchester Foundation Trust (MFT) in November 2024. <h3>Method</h3> A retrospective total sampling method was used. Across the four acute hospitals in MFT, 33 recently deceased adult inpatients with two or more documented sets of comfort observations were identified by reviewing the electronic patient record. Data were collected from comfort observation and medication charts, and medical and nursing documentation, then anonymised and analysed before comparing to predetermined standards of at least 80% compliance in: Comfort observations being referenced in nursing notes. Comfort observations being referenced in medical notes. Patients scoring on comfort observations having action taken. Patients scoring having their comfort observations repeated within two hours. <h3>Results</h3> Only two of the four hospitals in MFT met the first standard of ≥80% nursing notes containing reference to comfort observations. None of the other standards were met in any of the hospitals, with medical notes rarely containing any mention of comfort observations at all. <h3>Conclusion</h3> Although comfort observations are frequently recorded in patients approaching the end of their lives, they do not appear to have a significant impact on the care provided to these patients. Urgent review of the implementation of comfort observations and staff education is required to ensure opportunities are not missed for higher quality symptom control and comfort care in this important patient cohort.