An MDT approach to incorporating GSF into routine practice on a respiratory ward.

Abstract

Introduction The Gold Standards Framework (GSF) can identify people who are coming to the end of life. Earlier identification can prompt advanced care planning (ACP) discussions to be had sooner, therefore tailoring care to peoples' wishes. The aim of this project was for every patient on a 48-bed respiratory ward at a DGH near Birmingham to have an assessment of whether GSF is appropriate at admission, and to have this recorded. Methods Plan, do, study, act cycles were carried out: Junior teaching Consultant education Nursing education Junior teaching helped increase the number of GSF assessments, but due to the rotational nature of jobs and reluctance of juniors to initiate ACP discussions themselves this was not sufficient. Involving consultants was difficult but some started to incorporate GSF discussions into post-take ward rounds. Success was limited by high ward pressures. Nursing staff made the largest difference, as Senior Sisters created a column for GSF on the board round and prompted doctors of all grades for missing GSF assessments. Results Baseline data showed that 69% of patients had their GSF assessed in the month of June 2022. Following the first cycle this increased to 75.8% in September. After consultant education this increased to 84.5% in December. In the third cycle involving nursing staff, this increased to 92.6% of patients having GSF assessed throughout January 2023. Conclusions Involving the wider multidisciplinary team is a good approach for making GSF assessments routine on the ward. Positive change was seen in all interventions through education of different groups. Going forward, further data collection is required to ensure that the change was maintained. Measurement of other outcomes like documentation of preferred place of care would be a good indication of whether increased GSF assessments does lead to better care for patients.