Clinical audits are commonly used to identify opportunities for quality improvement (QI). The notion of ‘a good death’ and associated contributing factors are well described in the literature. Measuring the quality of care provision at end of life in residential aged care facilities (RACF) however, remains challenging. Multiple after death audit (ADA) tools are available but little is known about their use or whether they contribute to quality improvement.

To identify the prevalence, tools, barriers and facilitators of ADA in RACF in the Australian Capital Territory (ACT). 

A telephone survey of RACF in the ACT using purposive sampling between April and May 2022.

Of the 28 participating facilities 43% used an ADA tool. Tools identified included Moving On (n=5), purpose built ‘in house’ (n=5) and ELDAC (n=3). Only 33% described the audit data being used to inform quality improvement. Workforce characteristics including culture, professional maturity, and limited resources were identified as barriers to ADA. Respondents reported a need for further education and support for RACF staff.

The findings of this study revealed that ADA are not routinely conducted or used for quality improvement. Significant barriers exist to implementing ADA in RACF. Research is required to investigate if current audit tools are fit for purpose and are suitable for QI and achieving a ‘good death’ for residents and families. 

This QI project identifies gaps and barriers to ADA and QI in RACF. It highlights the need for further research in this area and the need for education, mentoring and support for the aged care workforce.

 

Juliane Samara1, Tricia O'Connor1, Paresh Dawda2

 
 

1.     Clare Holland House Specialist Palliative Aged Care, Calvary Public Hospital Bruce, Canberra, ACT, 2600

2.     Next Practice Medical Centre, Deakin, ACT, 2604