68 Improving recognition and management of terminal agitation in a hospice inpatient unit

<h3>Background</h3> Terminal agitation is a common symptom at the end of life. An audit of patients with terminal agitation in our inpatient unit (IPU) showed no patients with terminal agitation were assessed using a validated score. The modified Richmond Agitation-Sedation Scale (mRASS) was developed for intensive care settings but has been modified and validated for palliative care use.¹ <h3>Methods</h3> A flowchart incorporating the mRASS was introduced to the IPU to support the assessment and management of terminal agitation, including response to pharmacological management (PRN medications). Plan-Do-Study-Act cycles were used to evaluate interventions which included posters, educational sessions and daily drug chart reviews. <h3>Results</h3> Baseline data from April 2024 showed 100% (n=4) of patients had reversible causes of agitation considered, but none were assessed using the mRASS. By July 2024, 63% (n=5) of patients were assessed using the mRASS before the first PRN for terminal agitation, with 63% (n=5) of patients reassessed after. In August 2024, 50% (n=6) of patients were assessed using mRASS before the first PRN for terminal agitation, and 42% (n=5) of patients were reassessed after. <h3>Conclusions</h3> The use of the mRASS is both viable and effective for assessing terminal agitation in an IPU setting and helps quantify the response to PRN medications. There remain barriers to its use for all patients with terminal agitation and Plan-Do-Study-Act cycles continue. The decrease in the number of patients assessed using the mRASS in August is thought to be due to new staff starting work on the IPU at this time. <h3>Reference</h3> Bush SH, Grassau PA, Yarmo MN. et al. The Richmond Agitation-Sedation Scale modified for palliative care inpatients (RASS-PAL): a pilot study exploring validity and feasibility in clinical practice. <i>BMC Palliat Care</i> 2014;<b>13</b>:17.