National Care of the Dying Audit - Hospitals (NCADH)

One way of evaluating the level of care provided for patients dying on an LCP in our acute hospital trusts in the UK is to engage in a national audit project against which future provision of care could be measured.

National Care of the Dying Audit Hospitals (NCDAH)- 3rd Round

Marie Curie Palliative Care Institute Liverpool and the Royal College of Physicians National Care of the Dying Audit - Hospitals (NCDAH) 3rd Round
This audit is being led by the Marie Curie Palliative Care Institute Liverpool in collaboration with the Royal College of Physicians, and is supported by the Department of Health and Marie Curie Cancer Care. 

The NCDAH is part of a Continuous Quality Improvement (CQI) programme in care of thed ying that has been highlighted in the End of Life Care (EOLC) Strategy (DH, 2008) as one way of driving up the quality of care for dying patients.  CQI within the NCDAH facilitates audit and evaluations against 'national standards' in care of the dying, by comparing performance across different organisations against those standards.

Key to the success of this programme is that it also promotes the development of local action plans in order to effect change in the local healthcare environment for the care of patients in the last hours or days of life.

Aims of the NCDAH programme
A new focus for Round 3 is the potential for all Acute Hospital Trusts in England to participate in an organisational audit of provision for care in the last hours or days of life.

These organisational aspects of provision of care are linked to the EOLC Quality Markers (DH, 2009) and the CQC essential standards of quality and safety (outcome 4K) (CQC, 2010).  This audit will inform organisational Key Performance Indicators (KPI) for each hospital trust, for the provision of end of life care.

Building on the success of the NCDAH Round 1 and Round 2, the aim of the NCDAH Round 3 is to improve the standards of care for all patients who are expected to die, and who die in hospitals in England, specificially by:

• Enabling ALL Hospital Trusts in England to undertake an Organisational Audit of the provision of care for patients in the last hours or days of life within their organisation.
• Undertaking a national audit of care of patients in the last hours or days of life, in individual hospitals in England, as documented on the Liverpool Care Pathway (LCP) for the Dying Patient generic version 12 (or equivalent).  This audit will also inform clinical KPI's developed for each individual hospital.
• Enabling participating hospitals to compare their performance with that of others, against the goals of care contained within the LCP generic version 12 (or equivalent).

We are pleased to announce that the National Care of the Dying Audit Hospitals (NCDAH) Round 3 Benchmark Report has been published on 1st December 2011.

An Executive Summary of the Report is available by clicking here, the full generic report can be viewed by clicking here and a Press Release can be found here.

A Briefing Paper from the Marie Curie Palliative Care Institute Liverpool (MCPCIL) to accompany the above documents is available here.

Useful Links 

NCDAH Reports – Round 1 and Round 2 - to access, please click here.

• National End of Life Care Programme
  
• Department of Health (2008) End of Life Care Strategy: Promoting high quality care for all adults at the end of life 
  

• Department of Health (2009) End of Life Care Strategy: Quality Markers and Measures for End of Life Care

• Care Quality Commission (2010) Guidance about Compliance: Essential Standards of Quality and Safety
  
  
  NCDAH - Previous Rounds

   Round 1 of the audit- 2006/2007

Conducting the audit
One hundred and eighteen hospitals took part in the first round in 2006/2007 submitting data from 2672 patients whose care in the final days of life was driven by the LCP.  The audit provided individual hospitals with useful comparative information on the delivery of care in the last days of life and illustrated examples of excellence across the board. 

   Results of audit
Overall, the generic audit results revealed that while standards of clinical care for the individual patient were high, there was room for improvement in the assessment of insight and spiritual needs, particularly those of patients.  In general, communication with patients and primary care and information sharing both before and after the death of the patient remains a challenge.

• Generic full report (pdf, 72 pages)
• Summary Report (pdf, 20 pages)

Using the results 
Following the dissemination of the results, three regional workshops, attended by around 120 participants, were held to provide a forum for further discussion and action-planning for future improvement.  An overwhelming majority of participants felt that the workshops had provided a valuable opportunity to network and share good practice and that participation in the audit would lead to improvements in care of the dying in their hospitals.

• View the summary report  (pdf) of the workshops conducted.

Participants in the first round of the audit were invited to submit examples of good practice from their hospitals regarding improving the quality of care delivery to dying patients and their families. 

• View examples of best practice.

Round 2 of the audit - 2008/2009 

The second round of the National Care of the Dying Audit Hospitals was co-ordinated by the Marie Curie Palliative Care Institute Liverpool (MCPCIL) in collaboration with the Royal College of Physicians (RCP).

One hundred and fifty-five hospitals from within 115 acute hospital trusts in England provided a total of 3893 individual datasets for patients who were cared for in the final days and hours of life using the Liverpool Care Pathway for the Dying Patient (LCP). This represents a 32% increase on the number of hospitals that took part in round 1 and 104 hospitals participated in both rounds.  Round 2 also included a pilot cohort of 13 hospitals from 5 Trusts in Northern Ireland. 

New this round, alongside data from the goals of care on the LCP, information on the prescription and administration of medications for agitation and restlessness in the last 24 hours of life were reported, as well as data recorded on the variance sheets for a selection of goals.  Individual hospital reports were made available to participating hospitals in the summer of 2009.

These reports enabled hospitals to benchmark their relative performance on key domains of care (physical, psychosocial and spiritual, communication, information and adherence to policies and procedures) and to make comparisons with their performance in the previous rounds where appropriate.

Regional workshops were undertaken in the autumn of 2009 in Liverpool, London and Belfast, to allow participants to debate the findings and action plan for improvements in future care.  Importantly, the results from this round of the audit were also used to inform the development of Version 12 of the LCP, as part of the 2 year consultation exercice.  LCP generic version 12 was launched in December 2009. 

Results of the Audit

The second round of the National Care of the Dying Audit of Hospitals (NCDAH) shows that the majority of patients on the Liverpool Care Pathway for the Dying Patient (LCP) are receiving high quality care in the last hours and days of life.  Read the accompanying press release about the National Audit.  Copies of LCP documentation can be accessed here.