64 Gold standards framework implementation at Dudley group of hospitals NHS FT and approaches to improving identification

<h3>Introduction</h3> A third of hospital patients are in their last year of life and almost 50% of people die in hospital. At Dudley Group NHS Foundation Trust (DGFT) we have implemented the Gold Standards Framework (GSF) and we are able to record the GSF status on our hospital electronic patient record (EPR). Approximately 75% of deaths are predictable (Blackmore et al 2011), and at the Trust end of life care group this has been agreed as the recommended target of the percentage of patients with a DNACPR that should have a GSF status and this study was to review the percentage of patients with a DNACPR and GSF identified. <h3>Method</h3> An end of life care document is completed for patients identified as GSF on the EPR used at DGFT and the DNACPR is also recorded on the EPR. Therefore, on the 6th June 2024 all adult wards were reviewed to see the number of patients with a DNACPR and GSF document and those with a DNACPR and no GSF document. <h3>Results</h3> On the 6th June 2024 there were a total of 199 adult inpatients with a DNACPR. Forty eight percent (95) had a DNACPR without a coded GSF and 52% (104) had a DNACPR and coded as GSF. The data was broken down into ward areas and demonstrated a higher percentage of DNACPR with a GSF code for the majority of GSF accredited wards. <h3>Discussion</h3> As approximately 75% of deaths are predictable we are working with the EPR configuration team to develop a prompt when a Treatment Escalation Plan (TEP) is completed for the clinician to consider if GSF is appropriate to try to improve identification of patients in the last year of life. Identification is the essential first step to then developing an individual plan of care.