Recognising patients at risk of deterioration and dying on general medicine wards: a nurse-led point prevalence study

Objective: To trial the Supportive and Palliative Care Indicators Tool (SPICT) as a nurse-led initiative to describe the supportive and palliative care needs of patients in the acute general medical ward. Patient deaths within the subsequent 12 months were identified. Background: National standards specify recognition of patients at risk of deterioration and dying as essential to ensure high quality and safe end-of-life care. However, the timely recognition of these patients in acute medical wards is often complex and inherently uncertain. Method: A point prevalence study assessed the supportive and palliative care needs of patients admitted to the general medical wards of a major public tertiary hospital in a single day. A nurse-led team used the SPICT and the Surprise Question to assess patients. Patient deaths were identified one year following assessment. Results: Most admitted patients (n = 40, 93%) exhibited at least one advanced disease and two indicators of general deterioration on assessment. Of these patients, 40% died within one year. Only one patient was referred to the hospital-based palliative care service at the time of assessment. Conclusion: The SPICT identified a high prevalence of supportive and palliative care needs among general medicine inpatients. The use of the SPICT as a nurse-led initiative provides an opportunity to identify patients at risk of deteriorating and dying while also recognising areas of unmet need. Implications for research, policy, and practice: The SPICT can be effectively administered by nursing teams to assist with the identification of patients who may be at risk of deteriorating and dying so that appropriate end-of-life care decisions can be considered. Further work is needed to develop supportive measures to assist home teams in the identification and response to patients at risk of deterioration and dying in acute hospitals.