G364(P) What signs or symptoms indicate a child is likely to die within months or days and are they being used within this hospital

Background Clinicians must be able to spot when children with life-limiting and life- threatening conditions might be approaching the last 6–12 months of life, to allow time for advance care planning to be put in place. As yet, no prognostic indicator tool exists for paediatric palliative care. The Chameleon children’s end of life (EoL) care quality improvement project promoted the use of an EoL care prompt during 2018. The purpose of this audit was to then determine if the addition of prognostic indicators to the prompt tool may improve its use and thus the timely implementation of essential interventions. Objectives To determine locally used prognostic indicators for the last 6–12 months of a child’s life within this Children’s Hospital. To retrospectively ascertain if they have been used and if appropriate interventions have been completed from the EoL care prompt. Methods 12 healthcare professionals were interviewed to find locally used prognostic indicators. Children who died an expected death as a result of either an oncological or neurodisability disease from April 2017-September 2018 were identified for audit. Their medical records were reviewed to determine if these locally used prognostic indicators had been used and if appropriate interventions from the EoL care prompt had been recorded as completed. Results 7 locally used prognostic indicators were determined from interviews. Each of the 20 patients identified for audit had evidence of at least 1 of these in their notes. Interventions from the EoL care prompt were completed best in the last few days of life, however only 1 patient met the standard of completion of all interventions across the 3 sections. Conclusions Prognostic indicators are being used in the last few days of life, and these could be added to the EoL care prompt to improve its use. Despite this, not all interventions for EoL care are being completed. Further research is required to determine useful prognostic indicators and additionally to develop an effective Children’s EoL care planning tool, which would be an exciting future for improving children’s EoL care.