77 Mouth care and hydration at the end of life: A survey for medical staff

Introduction The regular assessment of hydration status and provision of mouth care are vital parts of care in the last days of life. We present the results of a survey assessing the knowledge and attitudes of medical staff towards mouth care and hydration at the end of life, based on recommendations from the National Audit of Care at the End of Life (NACEL, 2018) and from NICE Quality Standard 144. Methods A survey for medical staff was devised based on the above recommendations. This was sent in May 2020 to all junior doctors in Leeds Teaching Hospitals NHS Trust. Results Fifty three questionnaires were completed and the respondents varied from Foundation Year 1 doctor to Registrar, across a range of specialties. Only 8% of respondents indicated that they usually ask patients about their mouth problems, and 32% indicated that they rarely examine the mouth. A variety of barriers to oral assessment were highlighted: the most common being a lack of time, followed closely by a lack of priority, and a lack of training. Sixty percent felt confident assessing the hydration status of adults in the last days of life. The most common listed indication for CAH was to relieve distressing symptoms, or to provide comfort (53%). Sixty three percent reported feeling uncomfortable prescribing CAH, either due to a lack of knowledge or confidence, or because they felt it would be inappropriate (18%). Half reported a lack of confidence discussing CAH with patients and relatives. Conclusions This survey provided an insight into the knowledge and practice of junior doctors regarding mouth care and hydration needs at the end of life and has provided a focus for education. A fact sheet has been developed in response to this survey, in order to improve compliance with recommendations from NACEL and NICE.