81 Assessment of individualised end of life care plans in an Acute Hospital Trust – are we too late to capture patients’ wishes?

<h3>Introduction</h3> NICE’s guidance in ‘Care of dying adults in the last days of life’¹ sets out what information should be obtained and discussed when a patient is thought to be entering the last days of life. Individualised end of life care plans (IEoLCPs) document these discussions; they offer an explanation of the dying process, explore the psychosocial and cultural needs of patients and those close to them, and record the medical and care plan. Our local IEoLCP document has been designed in line with this guidance to ensure all aspects are addressed. This audit assessed how well teams were using our IEoLCP and whether this resulted in good discussions about end of life care. <h3>Method(s)</h3> Data was collected retrospectively for the months of April and October 2024, on 15 patients per cycle who had died with an IEoLCP in place, excluding ITU, ED, and paediatrics. The quality and extent of completion were assessed. A paper form was audited in April but an electronic version was in use by October. <h3>Results</h3> In both samples, patients were involved in only a minority of discussions (April 2/15 (13%), October 3/15 (20%)), because they were drowsy, confused, or unconscious. Family and friends were involved in most cases (April 12/15 (80%), October 15/15 (100%)). This resulted in omission of information on exploring patients’ preferred place of death, emotions, and cultural needs. <h3>Conclusions</h3> We found that our IEoLCP document fulfilled the NICE guidance,¹ however the exploration of patients’ wishes needs to happen earlier than the last days of life. By this time it is often too late to explore, identify, and fulfil patients’ wishes. Our local action plan is to consider implementing a modified treatment escalation plan (e.g. RESPeCT²), to include patients’ wishes in the weeks and months before death and allow earlier autonomous involvement. <h3>References</h3> Overview: Care of dying adults in the last days of life: Guidance (2015) NICE. Available at: https://www.nice.org.uk/guidance/ng31 RESPeCT | Resuscitation Council UK. Available at: https://www.resus.org.uk/respect