Improving The Patient and Family Experience At The End of Life Using A Multidisciplinary Death Checklist on EMR
Diana Truong1, Jessie Rowe2,4, Melissa Heywood3
1EMR Optimisation & Education Team, Royal Children’s Hospital, Parkville, VIC, Australia
2Paediatric Intensive Care Unit, Royal Children’s Hospital, Parkville, VIC , Australia
3Victorian Paediatric Palliative Care Program, Royal Children’s Hospital, Parkville, VIC, Australia
4Paediatric Infant Perinatal Emergency Retrieval, Royal Children’s Hospital, Parkville, VIC, Australia
Abstract
Background
The care required for a dying child and their family is complex and challenging for the family and clinicians involved. A multidisciplinary approach with clear communication and documentation is essential to ensure the delivery of great care. A review of current documentation following the death of child was completed with the aim of then developing a more streamlined multidisciplinary approach to documentation across the hospital.
During this review, several limitations were identified such as multiple checklists with minimal transparency across teams; existing checklists were only collecting data about the death itself and with limited ability to document the many options and actions taken. Further, this information was scattered across EMR notes or was not documented at all.
Methods
Two nurses collaborated with an EMR analyst to codesign a solution that would promote a seamless end of life experience for patients, families, and clinicians.
Results
A comprehensive Death Checklist was created and implemented to allow clinicians to document details around a patient’s death and share vital information such as the coroners process, memento making undertaken and follow up plans. The checklist included links to relevant clinical practice guidelines and enabled documentation by one clinician to be viewed in real-time by other clinicians. All clinicians in the hospital were provided access to the checklist.
Discussion
The implementation of the death checklist saw significant improvements in documentation. Completion rates increased from 11% (425/3804) to 75% compliance (179/236) since implementation of the checklist. A qualitative review is currently being conducted to evaluate its acceptability and impact.
Biography
Jessie is a Clinical Nurse Specialist in the Paediatric Intensive Care and Paediatric Retrieval Nurse for Paediatric Infant Perinatal Emergency Retrieval, Royal Children’s Hospital, Victoria where she has worked the past decade. Jess has a strong passion for high quality end of life care which she has advocated for through development of local guidelines and RCH Foundation funded projects. Jess is a current panel member of the Australian College of Critical Care Nurses End of Life Advisory group.