Abstract Details

Title Documenting End-of-Life Care in Patients with Neurological and Neurosurgical Conditions: How Are We Doing?

Topic Ethics, Pain and Palliative Care

Presentation(s) P02 - (-)

Poster/Presentation
Number 004

Objective

Background BACKGROUND: In EOL care, the need to act may overwhelm the need to document; thus, quality of EOL care may be underestimated by chart evaluation. In planning for the NPCP, current documentation was assessed to identify gaps that may be bridged by an EOL practice checklist.

Design/Methods DESIGN/METHODS: Part 1. Retrospective chart review of patients deceased at the MNI/H from October 2011 to March 2012 using a chart audit tool adapted from two available tools. Patients with a length of stay (LOS) ?48 hours were excluded. Data was collected by two abstractors and summarized statistically. Part 2. Qualitative interviews with family members and healthcare professionals of the deceased are now being conducted to identify mismatches between documentation and perceived care.

Results RESULTS: During the study period, 43 patients died; 8 were excluded (1 missing chart, 7 LOS ?48 hours). Of the remaining 35 patients, 43% were men, mean age was 69 (SD 15) and median LOS was 8 days. The main admitting diagnoses were cerebrovascular accident (57%) and amyotrophic lateral sclerosis (20%). Presence of living will was documented in 4 charts (11%), surrogate decision-maker in 2 (6%) and patients' preferences in 26 (74%). Median time from admission to discussion about and documentation of level of care was 3.5 days and 4 days, respectively. In the last day of life, pain and dyspnea were assessed in 66% and 83% of patients, respectively, and if present, a plan was documented in 83% and 76%, respectively.

Conclusions CONCLUSIONS: The documentation of care provided at EOL reveals gaps in communication, symptom assessment and management. A NPCP with an appropriate documentation system would help address these important EOL issues.

Authors/Disclosures
Sandra Derghazarian, MD (Brunswick Medical Center at Glen) PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file

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