Study led by UHSussex colleagues shows digital comfort checks improve quality of end-of-life care

Several customers across the UK have made use of Alcidion’s reconfigured Patientrack solution to provide palliative care symptom management.

The efforts led by the team at UHSussex highlight the significant advancements in patient care practices with the support of smart technology. Retiring paper charts for electronic comfort observations proactively signals the need for intervention, which has empowered colleagues to allocate resources effectively and respond promptly to patient needs.

This article was originally published by University Hospitals Sussex NHS Foundation Trust 25 April 2024.

Palliative care colleagues have developed a digital system that records comfort checks for patients receiving end-of-life care, in a study that demonstrated it improves their quality of care. 

In Sussex, more than a third of all deaths occur in hospital which is why the care of those in the final phase of their lives is a vital part of the care provided in hospitals.  

At UHSussex, the specialist palliative care teams offer support to those in the last stages of life, acting as an advisory service to support the care provided by teams on the wards. 

Dr Ollie Minton, Consultant Clinical Lead for Palliative Medicine at UHSussex said: “Our teams are experts in the management and support of patients who are dying but we know we are a small advisory team and cannot be everywhere, so education and culture change are vital to ensuring the highest quality of end-of-life care.” 

Building on their experience and best practice, the teams developed an electronic comfort observations chart and care plan for end-of-life patients to enable colleagues supporting these patients to have the tools they need to provide good care and empower them to feel confident in the care they are giving.  

Steve Bass, Lead Nurse for Palliative and End-of-Life Care said: “Dying is the only certainty of life. We have one chance to get it right, so people can die comfortably and with dignity. This system helps us to have oversight of all those people that are being cared for in our hospitals that have been identified as approaching the last hours or days of their life. It enables us to monitor their condition, their symptoms and respond effectively to ensure their comfort as they die.” 

Comfort observations are a part of routine care for a person who is dying and are a set of regular checks for five symptoms: pain, agitation, breathlessness, nausea, and fluid in airways, as well as the opportunity for additional concerns to be raised. 

This is in the form of a paper chart, completed by nursing colleagues on the ward who assess and score for the presence or absence of these symptoms, and escalate if symptoms are shown.  

The former paper chart has since been developed into an electronic format – electronic comfort observations (e-comfort obs) – using the same comfort checks as before that are now digitally recorded by nurses using a tablet. Like the paper version, this generates a symptom score that now proactively signals the need for intervention for better end-of-life care and enables colleagues to resource escalations accordingly. 

The digital system provides automatic prompts for nurses to reassess checks regularly, ensuring the patients’ needs are being met.  

It also offers guidance on steps to take if a patient is showing symptoms, such as when to give further medication, or when to escalate to a doctor, aiding better symptom control and improved comfort for the patient.  

The data from these checks is uploaded to the centralised patient tracking system, giving specialist palliative care teams insight into the assessments of these patients, identifying trends, and focusing where they may need to intervene.  

It also allows the teams to target wards where further education on best practice should be provided.  

Steve explained: “[Palliative colleagues] are the experts and have all the resources to help but we do need to empower as many staff as possible, as end-of-life care is a core business of the hospital.” 

A national audit by SEECare (Seeking Excellence in End-of-Life Care) revealed that the needs of people dying in UK hospitals without specialist palliative care guidance were not always met, including having avoidable physical symptoms and unfulfilled psychological, spiritual, and social needs. 

Over the 12-month study, 3,000 patients had their care supported with ‘e-comfort obs’ showing colleagues promptly and appropriately responding to symptoms and providing patients with an individualised, person-centred end-of-life care plans. 

Having spotted where our patients could be getting better end-of-life care, our colleagues have endeavoured to achieve the highest quality of care they possibly can and have used this digital innovation to drive this improvement and make change happen.  

Today, ‘e-comfort obs’ remain in place at UHSussex, and the team hope to share their work with other trusts and promote what is now a UK leading practice in end-of-life care.  

Last year, we released our Research and Innovation Strategy which sets out our five-year ambitions for healthcare research and innovation within the Trust and for the people of Sussex. This is in support of our vision of providing excellent care, every time for all our patients.