End of Life and Palliative Care Audit - Care Homes

Evidence to check

• • Staff can explain practical end of life care responsibilities
• • End of life and palliative care policy is current and accessible
• • Policy reflects national guidance and local pathways
• • Staff know how to escalate pain, distress, deterioration or family concerns

Evidence to check

• • End of life care training records
• • Staff can describe how they support dying residents and families
• • Observation or feedback shows compassionate communication
• • Staff receive additional guidance after concerns, incidents or difficult deaths

Evidence to check

• • Advance care plans
• • Records show resident involvement where possible
• • Preferred care arrangements, wishes and priorities are documented
• • Care plans are reviewed after deterioration, diagnosis changes or family discussions

Evidence to check

• • DNACPR or ReSPECT documentation where applicable
• • Decision-making records show resident or representative involvement where appropriate
• • Staff know where to find DNACPR information in an emergency
• • Records are reviewed after changes in condition, admission or care planning review

Evidence to check

• • Advance decision or advance statement records
• • Care plan reflects the resident's stated wishes
• • Staff can explain relevant wishes for residents they support
• • Any conflict or uncertainty is escalated to appropriate professionals

Evidence to check

• • Preferred place of care and death recorded where discussed
• • Staff can explain the resident's preferences
• • Professionals and family are informed where appropriate
• • Barriers to achieving the preference are recorded and escalated

Evidence to check

• • Care plan records spiritual, cultural, religious or personal wishes
• • Family, faith leaders or community contacts involved where requested
• • Rituals, prayers, music, objects or customs supported where possible
• • Staff can explain how individual preferences are respected

Evidence to check

• • Anticipatory medicine prescriptions
• • Medicines available before crisis where appropriate
• • MAR and administration records completed accurately
• • Nurse, GP, district nurse or palliative care advice recorded where required

Evidence to check

• • Medication storage checks
• • Controlled drugs register where applicable
• • Stock balances match records
• • Expired, discontinued or unused medicines are managed safely

Evidence to check

• • Symptom assessment records
• • Pain assessment tools, including tools for residents unable to communicate verbally
• • Care notes show response to symptoms
• • Escalation to GP, district nurse, hospice or palliative care team where needed

Evidence to check

• • Professional contact records
• • Multidisciplinary care planning notes
• • Advice from professionals reflected in care plans
• • Delays in professional input are escalated and recorded

Evidence to check

• • Communication records with residents and families
• • Changes explained sensitively and promptly
• • Family concerns are recorded and responded to
• • Consent and confidentiality are respected

Evidence to check

• • Care plan updates after deterioration or professional review
• • Handover records show staff were informed
• • Current care priorities are clear to day and night staff
• • Outdated interventions are removed or updated

Evidence to check

• • Observation where appropriate and sensitive
• • End of life care notes
• • Mouth care, repositioning and comfort checks recorded
• • Resident is not left distressed, exposed, uncomfortable or isolated

Evidence to check

• • Staff debrief records
• • Supervision or wellbeing support offered
• • Reflective learning after deaths
• • Managers recognise emotional impact on staff

Evidence to check

• • Records of family support conversations
• • Bereavement information provided where appropriate
• • Family wishes and needs considered before and after death
• • Signposting to bereavement or spiritual support where needed

Evidence to check

• • After-death care records
• • Verification and certification arrangements followed
• • Personal, cultural or religious wishes respected
• • Resident's body, belongings and room are treated with dignity

Evidence to check

• • Incident and complaint records
• • Review of delays in medicines, equipment or professional input
• • Lessons learned records
• • Care plans, training or pathways updated after learning

Evidence to check

• • Family feedback records
• • Compliments and complaints reviewed
• • Themes discussed in governance or quality meetings
• • Changes made following family feedback

Evidence to check

• • Referral records to hospice, palliative care team, GP, district nurse or specialist services
• • Complex symptoms or deterioration recognised early
• • Professional advice followed and recorded
• • Delays or refusals of input escalated where risk remains

Evidence to check

• • Staff scenario-based responses
• • Training records on recognising deterioration and last days of life
• • Care notes showing escalation of deterioration
• • Use of recognised deterioration tools or local pathways where applicable

Evidence to check

• • Care plan identifies sensory and communication needs
• • Glasses, hearing aids, communication aids or familiar objects used where appropriate
• • Staff adapt communication to the resident
• • Family input used to understand non-verbal signs of comfort or distress

Evidence to check

• • Care plan records approach to food, fluids and mouth care
• • Professional advice sought where swallowing or aspiration risk is present
• • Family discussions documented where intake reduces
• • Resident comfort and dignity guide practice

Evidence to check

• • Mental capacity assessments for relevant decisions
• • Best-interest decision records where the resident lacks capacity
• • Family, advocate, attorney or professional involvement where appropriate
• • Care plan reflects the decision and any limits on intervention

Evidence to check

• • Governance or quality meeting minutes
• • End of life care audits or reviews
• • Themes from deaths, complaints, feedback and incidents reviewed
• • Actions tracked and checked for sustained improvement

Evidence to check

• • Observation of room environment where appropriate
• • Privacy, noise, lighting and comfort considered
• • Family visiting and presence supported flexibly
• • Equipment, chairs, bedding or personal items arranged to support comfort

Evidence to check

• • Care plan or advance care plan records personal wishes
• • Family or representative input recorded where appropriate
• • After-death care reflects personal and cultural preferences
• • Staff can describe individual wishes for residents they support

Evidence to check

• • Records of resident support after a death where appropriate
• • Staff explain how they communicate sensitively with other residents
• • Residents' relationships with the deceased are considered
• • Emotional support, remembrance or pastoral support offered where appropriate

Evidence to check

• • Named end of life care lead or champion
• • Champion training or role description
• • Evidence of coaching, audits, staff guidance or pathway development
• • Links with hospice, palliative care or local end of life networks

Evidence to check

• • Records of delays and escalation
• • Contact with GP, district nurse, pharmacy, hospice or commissioners
• • Temporary risk controls while waiting for support
• • Impact on resident comfort reviewed and learned from