Palliative Medicine, North Bristol NHS Trust, Westbury on Trym, UK.
Care of the Elderly Medicine, North Bristol NHS Trust, Westbury on Trym, UK
BMJ Open Qual. 2024 Oct 26;13(4):e002821. doi: 10.1136/bmjoq-2024-002821.
Cultural, religious and spiritual (CRS) needs become increasingly important to individuals as they approach the end of life. CRS needs often remain unmet for patients dying in an acute hospital setting. The 'Just Ask' quality improvement project was designed to explore barriers to routine assessment of CRS needs, and to design resources and intervention to support staff to increase assessment of these needs.
The primary aim of the project was to increase the number of patients receiving end-of-life care in hospital with a documented CRS needs assessment from 43% (based on audit data) to greater than 50% over the 9-month project.
The study occurred in two phases.The scoping phase evaluated the current service, enablers, barriers and confidence in assessing CRS needs using an online staff survey and four staff focus groups. Results were analysed using qualitative content analysis, descriptive statistics and thematic analysis and informed the intervention phase.The intervention phase consisted of two Plan-Do-Study-Act (PDSA) cycles focusing on resource visibility/accessibility, organisational value placed on CRS needs assessment and staff education.Outcomes (documented CRS needs assessment) were measured by case notes review over 3 month periods - 1 year prior to and after the PDSA cycles. The impact of education interventions on staff confidence relating to CRS needs assessment were measured via an anonymous questionnaire.
Documented assessment of CRS needs increased from 43% to 57% in patients receiving end-of-life care in our hospital. Staff confidence scores in CRS needs assessment increased by 46-87%.
The factors that influence the addressing of CRS needs in a busy hospital are multifactorial. Organisational culture, appropriate resource provision and visibility, and education are essential factors in supporting staff to recognise, understand and engage with CRS needs assessment in patients receiving end-of-life care in hospital.
随着人们接近生命的尽头，文化、宗教和精神（CRS）需求对个人变得越来越重要。在急性医院环境中死亡的患者，其 CRS 需求常常得不到满足。“Just Ask”质量改进项目旨在探讨常规评估 CRS 需求的障碍，并设计资源和干预措施，以支持员工增加对这些需求的评估。
该项目的主要目的是将接受医院临终关怀且 CRS 需求评估有记录的患者数量从 43%（基于审核数据）增加到 9 个月项目期间的 50%以上。
该研究分两个阶段进行。在范围界定阶段，使用在线员工调查和四个员工焦点小组评估当前服务、促成因素、障碍和评估 CRS 需求的信心。结果使用定性内容分析、描述性统计和主题分析进行分析，并为干预阶段提供信息。干预阶段包括两个计划-执行-研究-行动（PDSA）循环，重点是资源可见性/可及性、组织对 CRS 需求评估的重视以及员工教育。通过 3 个月的病历回顾来衡量结果（CRS 需求的有记录评估），在 PDSA 循环之前和之后各进行一次。通过匿名问卷衡量教育干预对员工 CRS 需求评估信心的影响。
在我们医院接受临终关怀的患者中，CRS 需求的有记录评估从 43%增加到 57%。员工对 CRS 需求评估的信心评分增加了 46-87%。
影响在繁忙医院中解决 CRS 需求的因素是多方面的。组织文化、适当的资源提供和可见性以及教育是支持员工在医院接受临终关怀的患者中识别、理解和参与 CRS 需求评估的必要因素。
