by Jeremy Groves, Consultant Anaesthetist in Intensive Care
I’ve just been looking at the last Annual Report for the North Trent Critical Care Network and, if you look at the Network Units as a whole, the mortality rate is about 16%. This equates to over a thousand deaths. Now a death is not just a statistic. To the relatives left behind, and to carers, there can be significant trauma. This is true even for those with significant co-morbidity where death is always in the shadows. It makes bereavement care a real and important issue.
“Now a death is not just a statistic. To the relatives left behind,
and to carers, there can be significant trauma.”
The article by Berry et al in the February issue of JICS (1) has highlighted this area. In a national audit, they assessed compliance with the nine standards set out in the Society’s 1998 Guidelines for Bereavement Care in Intensive Care Units (2). Of the 144 eligible Trusts, they obtained information from 113 through a telephone survey. The results provide a mixed picture as to the degree to which the recommendations have been taken on board.
Most units (96%) provide written information to bereaved relatives and three quarters gave signposts to where further support was available. While 77% of units routinely informed the patients GP, the relatives GP was only informed on an ad hoc basis. 81% of units had a folder with information on religious rites and local services and support groups available to help them.
Something I perceive as being of real concern is that only in 47% of units do staff have access to bereavement training. Similarly, access to formal staff support following caring for a dying patient was only available in about half the units surveyed though a similar number indicated informal processes in this area. Three quarters of responders felt that their physical facilities for managing bereaved relatives were inadequate.
“There is still a lot to be done to meet the 1998 guidance
and, in a way, it almost seems to have gone off the radar. “
In their conclusion, the authors, while recognising areas of good practice, lament the state of bereavement care in UK ICUs. There is still a lot to be done to meet the 1998 guidance and, in a way, it almost seems to have gone off the radar. While GPICS discusses end of life care, the word bereavement does not occur in the document. Jeremy Hunt recently announcemed that every death in English ICUs was to be examined in more detail. That’s all well and good but bit more time invested in the relatives of the deceased and the staff who looked after them wouldn’t go amiss too.
When I read the article, I looked at the ICS website and found that the guidelines had been omitted from our site; a situation now rectified. None the less the guidance is now almost 20 years old and, while most of the information contained in the guidance is still very relevant, it could do with a review. To that end I have highlighted the area to Steve Webb, one of the Chairs of the Joint Standards Committee, which has both the remit to revise the guidance and oversight of GPICS – watch this space.
- Time for change? A national audit on bereavement care in intensive care units, JICS Volume: 18 issue: 1, page(s): 11-16, M Berry1, E Brink2, V Metaxa2 1Imperial School of Anaesthesia, London, UK 2King’s College Hospital, London, UK