Authors (including presenting author) :
LAM WY, WU YC, CHAN WC, CHEUNG KC, HO SM, TSO YK
Affiliation :
Department of Medicine & Geriatrics, United Christian Hospital
Introduction :
Palliative care aims to provide comfort and dignity to patients during the end-of-life (EOL) phase. Despite the availability of EOL guidelines and nursing reminder checklists in Kowloon East Cluster, challenges such as inconsistent practices, insufficient staff awareness, and inadequate training have hindered effective implementation. To address these challenges, a comprehensive EEE (Elevate, Empower, Enhance) bundle of care was introduced in 2021. This initiative focused on elevating care quality, empowering staff, and enhancing patient outcomes.
Objectives :
- To enhance staff awareness, competence, and ability to deliver timely EOL care
- To proactively identify EOL cases
- To improve staff participation in initiating EOL care including new staff
Methodology :
An EOL workgroup was formed in 2021 to lead and coordinate the initiative. Key measures include:
1. Staff Training: Yearly refresher courses for existing staff and annual orientation for new staff to ensure consistent EOL care practices.
2. Daily Patient Screening: Trained duty-in-charge nurses screened patients daily for signs of the dying process, enabling timely identification of EOL patients.
3. Practice Evaluation: Bedside audits by workgroup members to proactively assess and improve nursing practice in EOL care.
4. Digital Indicators: An EOL tag integrated into the digital floor plan to enhance staff awareness and care coordination.
Data were collected to evaluate the impact of these interventions, focusing on the timely initiation of EOL care, percentage of EOL cases among total deaths, and new staff participation in EOL care.
Result & Outcome :
Results
The percentage of EOL cases where patients passed away within a week of identification increased from 76.5% in 2021 to 90.5% in 2024, indicating improved staff competence and ability to deliver timely EOL care. The identification of EOL cases among total deaths rose from 17 cases (13.9%) in 2021 to 20 cases (26.7%) in 2024, reflecting enhanced identification and management of dying patients. Additionally, new staff initiating EOL care increased from 0 case in 2021 to 6 cases (30%) in 2024, demonstrating the effectiveness of the training programs in equipping new staff with essential skills and confidence.
Conclusion
The EEE bundle has successfully enhanced palliative care quality through the four key measures outlined. The timely identification of EOL cases, the notable increase in EOL case identification and new staff participation highlight the sustainability and impact of these interventions for service improvement, underscoring the benefits of EEE approach.
