End-of-Life Escalation Planning Audit

This project audits whether adults approaching the end of life, or adults for whom treatment escalation decisions are clinically relevant, have clear, documented, person-centred and accessible escalation plans. It reviews recognition of the end-of-life or deterioration context, treatment escalation plans and ceilings of treatment, DNACPR and ReSPECT or local emergency care plan documentation, capacity and best-interests processes, involvement of the person and those important to them, palliative care input, symptom control and anticipatory planning, preferred place of care, communication to the wider team, accessibility of the plan, transfer and out-of-hours handover, review arrangements and individual, spiritual or cultural needs.

• Acute medicine, frailty, ward and emergency teams making escalation decisions
• Palliative care, hospice, care-home, community and GP practice teams
• Nursing teams, pharmacists where anticipatory prescribing is reviewed, ACPs and PAs
• QI leads, governance teams, supervisors and educators

• Measure whether end-of-life escalation plans are recognised, documented and clinically clear
• Assess capacity, best-interests and shared decision-making documentation where relevant
• Review communication, accessibility, transfer and review of escalation plans
• Identify variation across care settings, assessment contexts and clinical areas
• Generate governance-ready and ARCP-ready evidence and a re-audit cycle

• Anonymous case identifier
• Inclusion / eligibility decision
• Anonymised context (age band, sex/gender recorded, care setting, assessment context)
• Clinical area / location and optional specialty / service
• Nineteen end-of-life escalation planning criteria (met / not met / not applicable)
• Free-text learning points and any project custom fields

• Live dashboard
• Audit report (Word)
• Executive summary (Word)
• Excel workbook
• PowerPoint presentation
• Conference poster
• ARCP evidence summary

• Designed to use anonymised or pseudonymised audit identifiers.
• This tool supports, but does not replace, clinical judgement.
• Local policy, formulary and specialist advice should be followed.
• Organisations remain responsible for local governance arrangements.
• This tool supports, but does not replace, clinical judgement. Follow local end-of-life, DNACPR, ReSPECT, capacity and escalation policy and specialist advice.
• Treatment escalation decisions, CPR decisions, admission, place-of-care and anticipatory prescribing decisions remain locally configurable and are not national standards.
• Use anonymous case identifiers only — never patient-identifiable information.

Supporting guidance from the Lazomis QI Resource Library. Authoritative clinical standards referenced by this project remain separate.

• Patient SafetyEscalation Failures: Understanding and Preventing Harm in Clinical PracticeEscalation failures are a significant contributor to avoidable harm in healthcare. This guide explores their root causes and outlines practical steps for NHS staff to improve communication, clinical handover, and timely senior review.
• Quality ImprovementPlanning Effective PDSA Cycles for Quality ImprovementThis guide provides a practical, step-by-step approach to planning effective Plan-Do-Study-Act (PDSA) cycles for quality improvement initiatives within the NHS, focusing on robust design and learning. It covers essential considerations from defining your aim to anticipating challenges, helping teams systematically test changes.
• Clinical GovernanceIntegrating Quality Improvement into Clinical Governance FrameworksThis article explores the vital relationship between Quality Improvement (QI) and Clinical Governance within the NHS, demonstrating how they are two sides of the same coin when aiming for continuous, systematic improvement in patient care.
• Quality ImprovementHow Many PDSA Cycles Does a Quality Improvement Project Need?This guide explains the iterative nature of PDSA cycles and offers practical advice for determining the appropriate number of cycles needed for effective quality improvement in NHS settings.