Dying in two acute hospitals: would usual care meet Australian national clinical standards?

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Journal Article
Australian Health Review, 2014, 38 (2), pp. 223 - 229
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The Australian Commission for Quality and Safety in Health Care (ACQSHC) has articulated 10 clinical standards with the aim of improving the consistency of quality healthcare delivery. Currently, the majority of Australians die in acute hospitals. But despite this, no agreed standard of care exists to define the minimum standard of care that people should accept in the final hours to days of life. As a result, there is limited capacity to conduct audits that focus on the gap between current care and recommended care. There is, however, accumulating evidence in the end of life literature to define which aspects of care are likely to be considered most important to those people facing imminent death. These themes offer standards against which to conduct audits. This is very apt given the national recommendation that healthcare should be delivered in the context of considering peoples wishes while always treating people with dignity and respect. This work describes a gap analysis undertaken to explore if issues defined as important by people facing imminent death would have been addressed by usual care of the dying in general hospital wards. The specific issues examined included the documentation that was available to define that this person was likely to die soon and how engaged the person dying seemed to be in discussions, how the person was monitored to ensure distressing symptoms were addressed when necessary and what investigations were considered necessary after the time the person was identified as dying.
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