P-198 Quality improvement project to integrate outcome assessment and complexity collaborative (OACC) suite of palliative care outcome measures into hospice clinical practice

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Background The OACC suite of palliative care outcome measures includes Phase of Illness, Australian-modified Karnofsky Performance Scale (AKPS) and Integrated Palliative Care Outcome Scale (IPOS). IPOS is a standardised, well-validated and global measure of symptom burden developed to identify and assess the symptoms and concerns most important to patients and their families (Bradshaw, Santarelli, Mulderrig, et al. Palliat Med. 2021;35(2):397–407). Studies show that using OACC in clinical practice improves patient care (Dudgeon. J Palliat Med. 2018; 21(S1): S-76–S-80) and enables better delivery and evaluation of patient care (Greenhalgh. Qual Life Res. 2009;18(1):115–23). Baseline audit data from our hospice showed low rates of completion in community and outpatient teams. Aims OACC suite of outcome measures integrated into clinical practice across the organisation to improve quality of patient care. Methods From July 2023 to April 2024 Quality Improvement methodology with Plan Do Study Act (PDSA) cycles were used to test and analyse rapid changes. In Phase 1 of the project the focus was on staff assessing and recording OACC. The outcome measure of IPOS completion at all the clinically relevant points was checked in hospice community and outpatient MDT meetings at the end of each PDSA cycle. Results After four PDSA cycles over the initial 8 months of the project the use of IPOS within community and outpatient teams increased from a baseline of 0–50% to 100% for new patient assessments and from 0% to 46–83% for follow up assessments. Conclusion Staff engagement and feedback on the project via teaching sessions and IPOS staff champions, as well as changing the format of the templates on the hospice electronic patient records to incorporate the OACC suite measures, were the changes that significantly increased and sustained the use of OACC measures within the hospice. Phase 2 will focus on using OACC to guide patient care within multidisciplinary meetings and gathering cohort data to demonstrate the impact of hospice interventions on patient care.

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