Authors (including presenting author) :
Ng NHY(1), Lam SK(2), Cheung WY(2), Lam PT(2), Tsang WY(2), Ho SM(2)
Affiliation :
(1)Nursing Services Division, (2)Department of Medicine and Geriatrics, United Christian Hospital
Keyword 1: :
End-of-life care
Keyword 2: :
acute care setting
Keyword 3: :
palliative care bundle
Introduction :
The large proportion of deaths occurred in acute wards signifies the importance of quality end-of-life care(EOLC) beyond Palliative Care(PC) setting. A PC bundle with multifaceted intervention including a care reminder for patients in the last days of life(CRPLDL), talks and workshops to frontline staff, EOLC link nurse system, palliative nursing round and palliative consultative service was initiated in United Christian Hospital(UCH) phase by phase since 2011. The tool (formerly named ‘Care Checklist for the Imminently Dying’ and was revised as CRPLDL in 2018) devised by PC team for guiding EOLC has been launched in three departments (medicine & geriatrics(M&G), surgery, and oncology) in UCH in phases over 14 years with serial reviews.
Objectives :
To evaluate the effect of the PC bundle on EOLC in acute wards in 2025.
Methodology :
Case records of all deaths during the period of July 1-31, 2025 in 18 acute wards (13 M&G, 4 Surgical, and 1 Oncology) were reviewed to identify the medical condition prior to death. A standard audit record sheet was used for data collection. Descriptive statistics were applied in data analysis.
Result & Outcome :
The effect of the PC bundle on EOLC was reflected by the review of the usage of the CRPLDL.
During the review period, a total of 169 deaths occurred. Fifty-two percent(n=88) were non-cancer death. Nearly ninety percent(n=151) were prescribed DNACPR order. Thirty-one percent(n=53) used the CRPLDL. The range of and mean duration of using it was 1-16 days and 3.2 days respectively. The main categories of not using it were classified into: i) death occurred within 24 hours after admission(20.7%, n=24); ii) sudden death with CPR after 24 hours of admission(6%, n=7); iii) receiving aggressive life-sustaining therapy even though death was anticipated(21.6%, n=25); iv) receiving palliative measures mainly when death was anticipated(45.7%, n=54); and v) other reasons(5.2%, n=6).
When comparing the results with previous reviews in 2011, 2014 and 2017, the percentage of DNACPR order was increased and sustained at nearly 90%. The usage of the CRPLDL was higher than in 2017(26%). The percentage in patients receiving palliative measures when death was anticipated though CRPLDL was not used was slightly decreased from 53.2% in 2017 to 45.7% in 2025 but was still higher than that in 2014(26%). There was an increase in patients receiving aggressive life-sustaining therapy despite death was anticipated(from 18.2% in 2017 to 21.6% in 2025). Conclusion: The effect of the PC bundle on EOLC in non-PC setting was shown by the empowerment of frontline staff in initiating comfort measures for patients in the last days of life. Regular training and skills transfer from PC specialists to staff of acute care setting on advance care planning is recommended.
