reviewed by Palliative Care team and compare the results with
best practice guidance and the Gosport.
Methods The audit cohort was consisted of all patients who
died in CCC between July 2018 and December 2018. 29
deaths were identified. Electronical medical records and paper
prescription charts were reviewed regarding opiates and
Results 84% of patients reviewed was not opioid na¯ve on
admission. 80% of patients were commenced on syringe
driver during admission. Commencement of syringe driver
was justified in 96%. In the remaining 4%, syringe driver
use was appropriate, but it was not justified. Starting and
finishing doses of opiates in syringe drivers were variable,
whereas PRN opiate prescription was appropriately dosed in
all cases. In 2 cases where the conversion was not according
to the guidelines, rationale was given. Similar results were
retrieved regarding midazolam prescription. Midazolam was
prescribed in 90% cases in patients with syringe driver.
Doses of midazolam in syringe driver ranged from 5 mg to
60 mg with appropriate justification of doses. There was no
direct correlation between commencement of syringe driver
and death. In 100% of cases, clear adherence to the clinical
guidelines was shown.
Conclusion Current practice in prescribing opiates/sedatives
and commencement of syringe driver is according to the clini-
cal guidelines and dosing is appropriate. Results of this audit
compared with results produced by the Gosport Independent
Panel provide assurance about current use of these medications
at CCC. Nevertheless, continuous training is necessary for pre-
scribers in order to maintain the reassuring results.
70 FINDINGS FROM THE FIRST ROUND OF THE NATIONAL
AUDIT OF CARE AT THE END OF LIFE (NACEL)
Suzanne Kite, Elizabeth Rees, Claire Holditch, Debbie Hibbert. NHS Benchmarking Network
NACEL is a national comparative audit of the quality and
outcomes of care experienced by the dying person and those
important to them during the last admission leading to death
in acute, community hospitals and mental health inpatient pro-
viders in England and Wales. The audit, first undertaken dur-
ing 2018/19, comprised:
.an Organisational Level Audit covering trusts (in England)/
Health Boards (in Wales)
.a Case Note Review completed by acute and community
providers only, reviewing all deaths in April 2018 (acute
providers) or deaths in April –June 2018 (community
.a Quality Survey completed online, or by telephone, by the
Data was collected between June and October 2018. 206
trusts in England and 8 Welsh organisations took part in at
least one element of the audit (97% of eligible organisations).
A total of 11,034 case note reviews were included. Key find-
ings included the following: -
.Documentation that a person may die imminently was high.
For half of patients, imminent death was recognised less than
one and a half days before they died, leaving a limited amount
of time to discuss and implement an individual plan of care.
.People’s experience of care was good, excellent or
outstanding in most cases (80%), as reported by the Quality
Survey. However, 20% felt that there was scope to improve
the quality of care and sensitive communication with both the
patient and the family/others.
.Governance of end of life care was strong.
.Improvement is required in the documentation of an
individual plan of care (documented evidence of a plan for
62% of people who died). Similarly, for one third of people
who died, a discussion about the plan of care, and discussions
about medication, hydration and nutrition had not been
The second round of NACEL is running in 2018/19.
71 ‘IS THIS A CONVERSATION ABOUT DEATH?’PLANNING
FOR FUTURE CARE WITH PATIENTS WITH ADVANCED
CANCER: EXAMINING THE FEASIBILITY OF USING THE
TRAJECTORY TOUCHPOINT TECHNIQUE FOR ADVANCE
CARE PLANNING. A QUALITATIVE STUDY
Daniel Lewin, Jessica Lee, Lynn Sudbury-Riley, Philippa Hunter-Jones, Stephen Mason,
Farnaz Nickpour, Ahmed Al-Abdin, Sarika Hanchanale, Simon Roughneen, Amy Reed,
Bob Giles, John Ellershaw. Royal Liverpool and Broadgreen University NHS Hospital Trust,
University of Liverpool
Background Advance Care Planning (ACP) enables people to
make plans regarding their future healthcare and has been
shown to positively impact on the quality of patient care.
There are multiple barriers to engaging in the process of
advance care planning. These include a lack of understanding
of what ACP entails and patient, relative and healthcare pro-
fessionals’anxieties in discussing potentially distressing issues.
The Trajectory Touchpoint Technique (TTT) was applied to
ACP discussions in order to create a visual aid to help cir-
cumvent these barriers, allowing deep and detailed discussions
of potentially distressing topics.
Methods A literature review was performed to identify topics
that patients may have wanted to talk about. These were
ratified through a human centred design process (Design
Thinking) with members of the public. ACP discussions were
performed using the visual aid on an in-patient specialist pal-
liative care unit. Qualitative enquiry was used in the form of
patient, relative and clinician interviews following ACP dis-
cussions to evaluate the feasibility and benefits of using the
Results Data was collected over a 4 week period in a single
acute in-patient palliative care unit. Patients (n=4), relatives
(n=2), and clinicians (n=3) participated in the study. Thematic
analysis of interview transcripts showed the visual aid enabled
patients to begin the conversation by talking about the ACP
related issues they felt comfortable with and that were most
important to them. Relatives found the visual aid helped to
identify what issues can be discussed. Clinicians found the vis-
ual aid helped focus the ACP discussions.
Conclusions We have demonstrated that the visual aid was
useful in facilitating ACP discussions with this cohort of
patients, relatives and clinicians. Further, we suggest these
findings warrant trials across primary and secondary care for
patients in end-of-life to further develop this approach to
SPCARE 2020;10(Suppl 1):A1–A84 A33
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