PPF26 Symptom observation in intensive care at the end of life: the use of a novel chart in assessing and managing symptoms

<h3></h3> With a 11.8% mortality rate in Scottish intensive care units (ICUs), provision of high quality end of life care (EOLC) is vital. We proposed the creation of a bespoke symptom observation chart (SOC) building upon work undertaken in other ICUs. Patients received a numerical score based on symptom severity which determined immediate action, need for medical review and frequency of monitoring. A survey of ICU staff was completed in order to assess confidence in EOLC management. Staff were asked to give confidence ratings relating to a number of statements. The SOC was then refined utilising this data, alongside feedback from inpatient stakeholder. The survey was then repeated after six months. Additionally, patient notes over this six-month period were analysed retrospectively in order to assess SOC completion, use of medication, review of regular medicines and documentation of EOLC. Of 55 deaths between November 2024 and May 2025, three patients’ case notes were unavailable (n = 52). 12 (23%) had a SOC in place. All patients with a SOC had anticipatory medicines prescribed, compared with 30% (12/40) in other patients. Only six patients had a syringe driver prescribed, five of whom had a SOC. Survey data showed an increase in staff confidence in assessing symptoms. Overall, 96% (24/25) of staff felt the introduction of a SOC was beneficial to the way they assessed and cared for patients. The use and implementation of a novel SOC within an 18-bedded ICU has shown a demonstrable impact on both staffing confidence in the assessment, treatment and escalation of EOLC symptoms as well as the implementation of key interventions to manage symptoms associated with dying. This SOC could be assessed and trialled for use in larger centres as well as other acute hospital environments.