66 Reviewing procedures conducted in the last days of life in an acute hospital

<h3>Introduction</h3> NICE NG31 Care of dying Adults in the last days of life recommends: ‘Avoid undertaking investigations that are unlikely to affect care in the last few days of life unless there is a clinical need to do so.’ A sample of patients who died at The Dudley Group NHS FT with a coded investigation/intervention in the last 48 hours were identified to retrospectively determine the appropriateness. <h3>Method</h3> All patients admitted between 01/11/2022–30/04/2023 with discharge method as ‘death’ who received a coded procedure in the last 48 hours were identified. A random sample of 50 cases were then reviewed. <h3>Results</h3> Most patients had a short admission; with 32% admitted for less than 48 hours before death. Most patients were admitted from home (96%). All reviewed cases had documentation of recognition that the patient was dying; with 92% identified and coded as GSF Red or Amber. Most of the procedures conducted were done before recognition of dying. However, 11 cases when a patient had a catheter inserted, all were documented as part of symptom control. Six patients underwent intervention following recognition that a patient was dying where other interventions had been rationalised (12% of sample). 4 patients had a single blood test taken and 2 received non-invasive radiology based on order placed when focus of care had been on more active interventions. <h3>Discussion</h3> The review provides assurance that 92% of all cases were identified as either GSF Red or Amber during the admission, particularly given the short duration of admissions for the patient cohort. Once a patient is identified as dying, there is evidence non-essential interventions are reviewed as part of an individualised plan of care. The results were shared at Trust end of life care group to review the process for cancelling investigation requests on the local electronic patient record.