Lulu Mathews1, M. M. Sunilkumar2, Karen Anderson2

School of Public Health, SRMIST Kattankalathur Campus, Chengalpattu

1Institute of Palliative Medicine, Kozhikode, 2Pallium India, WHO Collaborating Centers (WHOCC) for Training and Policy on Access to Pain Relief, Trivandrum.

Email: iterrymize@gmail.com

ABSTRACT

Background: Assessing the death and dying experience of individuals with palliative care needs is crucial for maintaining quality standards in care delivery. The lack of a culturally relevant tool for the Indian population, the complexities of end-of-life care and the lack of institutional priority for quality assessment and improvement have hindered such assessments. The Institute of Palliative Medicine, Calicut, is a pioneering institute in India, that is delivering palliative care services for the last three decades. However, an objective assessment of the death and dying experience of patients has never been carried out.

Objective: The objective of the study is to increase the assessment of death and dying experience of in-patients from 0% to 50% by June 2019.

Materials and Methods: A3 methodology of quality improvement was used. To explain patient intake, care, discharge, death and bereavement assistance, a process map was created. A fishbone analysis was performed to understand the root causes for not performing the death and dying assessment. The causes were placed on a 2 × 2 grid and key drivers were created. The lack of a culturally suitable instrument was identified as a major barrier. Thus, a tool was developed and implemented.

Results: Weekly assessment targets and outcomes were plotted on a run chart. Assessments improved after the introduction of the instrument and other interventions. Sustainability measures kept the assessment of death and dying experience over 50% on the run chart.

Conclusion: Using the A3 quality improvement technique helped uncover root issues, create key drivers and meet assessment targets. This exercise helped the institute identify service gaps and recommend changes.

Keywords: Assessment, Death and Dying, Quality Improvement