Audit Review. An Opportunity to Press the Pause Button (Presentation from Dublin Community Hospital Network, February 2013) (DCN3)

1. An Opportunity to
Press the “Pause” Button
Dr Kathleen McLoughlin
National Audit and Review Co-ordinator (End of Life)

2. Why do we need to audit and review
end of life care?

3. Institutionalisation of End of Life Care in
Western Society

4. Place of Death in Ireland (2010)

5. Remember ‘The Wish’?

6. “Caring for older people and those approaching the end of
their lives is rightly said to be a litmus test for health and social care
and indeed a measure of our whole society…As well as more effective
inspections of hospitals, greater scrutiny and clearly understood
standards about patient safety, treatment and care, staff at all levels
must feel able to voice their concerns with confidence that senior
managers will take these seriously and act upon them. This requires a
new approach...including…core training in caring for people
approaching the end of their life, and embedding measures of patient
experience throughout all health and care settings.”
Eve Richardson
Chief Executive of the National Council for Palliative Care and the Dying Matters Coalition
Feb 2013 in response to the Francis Report

7. What do we know already?

10. There is lack of agreement…

11. The Pilot System

12. • Audit is now becoming central feature of the healthcare system in Ireland
• Purpose: to support a process of continuous improvement in the care of
persons at the end of life from the perspective of staff and relatives/friends
• Applicable to all adult deaths regardless of diagnosis or whether the death
was sudden/expected
• For expected deaths the focus is on the care provided during the last week
of the deceased person’s life
• Designed to review deaths in all care settings
• Builds on the National Audit 2008/9 and is underpinned by the Quality
Standards for End-of-Life Care & Standard 16
• Developed in partnership with HSE Quality, Safety & Risk Directorate and
the HSE Clinical Strategy & Programme Directorate
• Consultation took place with HIQA, HSE Palliative Care Working Group,
HQIP (UK) Help the Hospices (UK)

13. Components of the System
1. Audit tool for use in staff meeting
2. Bereaved relatives/friends questionnaire
3. Quality improvement questionnaire
For the pilot phase a 4th component will be included:
4. Independent assessment of the usefulness of the
audit tool by audit manager
All components are aligned to the domains of care
Cognitive testing

14. Aims and Objectives
• To support a process of continuous improvement in the care of persons at the end
of life, including their families.
This will be achieved through the following objectives:
• To facilitate staff to review and reflect on the structures, processes and outcomes
of end of life care provided.
• To carry out an independent assessment of the audit tool for staff with a view to
establishing its validity and reliability.
• To survey bereaved relatives to determine their perspective on the experience of
the patient’s care in the last week of life.
• To observe how audit meetings are held and facilitated to assess support that
facilitators may require to ensure that these meetings are inclusive, constructive,
and capable of bringing about improvements in care as required.
• To document the quality improvements that have taken place at each site as a
result of the audit.
• To build a national database on end of life care which (1) assists each site and
setting to review its care; (2) gives a national overview of the quality of care
provided to persons during the last week of life; (3) facilitates further research and
development on the audit system.
• To prepare regular reports on the quality of end of life care with a view to
promoting continuous improvement.

15. Progress to Date

17. Progress to Date

18. But it’s more than numbers…
• Staff support
• Improved communication
• Quality improvement plans
• Training needs analysis

20. The Future…
• Site reports
• Workshop (Monday)
• Pilot report (End April)
• Modification
• Roll Out Nationally

22. Acknowledgments
• Dr Kieran McKeown
• Mary Bowen
Who developed the system prior to its pilot
implementation nationally.
• Grace O’Sullivan
• Jackie Crinion
Thank you
Kathy.mcloughlin@hospicefoundation.ie
0894667915