judgement and therefore not placed in a category, illuminates the case and its management for the reader. Box 5 Overall care Comment type score 5 and category Admission Good initial assessment. Pos/C Phase score 5 Heart failure identified and confirmed radiologically and Pos/C appropriate treatment commenced. Important differential diagnoses considered and also treated Pos/C for chest infection. Early Regularly reviewed as he failed to improve and significant Pos/B management effort made to optimise his medication. Pos/C Phase score missing Later Ceiling of treatment considered, documented and Pos/C management communicated to family. When it became apparent that his Phase score 5 situation was hopeless, active treatment was withdrawn. Again, communication with the family was good and documentation was clear. Pos/C Overall care Well looked after. Pos/C Score 5 A decent attempt to treat her from a difficult starting point. Pos/C Good multidisciplinary involvement and good communication with the patient and family throughout. Pos/C Pos/C Box 6 is an example of how the impact of one adverse event may impact on the overall score, even when care is good in other components of care. Just at the point when the patient died, an inappropriate action occurred which the reviewer regarded as very unsatisfactory, although it did not contribute to the death. The patient’s reviewer gave high care scores for three phases but then deemed the overall care poor because of the adverse event at point of death. Box 6 Overall care Comment type score 1 (Pos or Neg) and category Admission excellent history taking and clinical examination. Oedema of Pos/C Phase score 5 feet not recorded though is noted in subsequent ward Neg/ B examinations. Early appropriate medical management. Pos/C management Decision taken to manage conservatively as end stage heart Phase score 6 failure Later discussion with family about end stage heart failure. management Decommissioned ICD as was appropriate Pos/C Phase score 6 Overall care Excellent management as deemed appropriate in this Pos/ C Score 1 terminal situation. DNR form done by team. Despite this when patient was in periarrest situation, patient Neg/ C was given 1 DC shock. This did not seem appropriate at all as DNR decision was discussed with the family.
judgement and therefore not placed in a category, illuminates the case and its management for the reader. Box 5 Overall care score 5 Comment type and category Admission Phase score 5 Good initial assessment. Heart failure identified and confirmed radiologically and appropriate treatment commenced. Important differential diagnoses considered and also treated for chest infection. Pos/C Pos/C Pos/C Early management Phase score missing Regularly reviewed as he failed to improve and significant effort made to optimise his medication. Pos/B Pos/C Later management Phase score 5 Ceiling of treatment considered, documented and communicated to family. When it became apparent that his situation was hopeless, active treatment was withdrawn. Again, communication with the family was good and documentation was clear. Pos/C Pos/C Overall care Score 5 Well looked after. A decent attempt to treat her from a difficult starting point. Good multidisciplinary involvement and good communication with the patient and family throughout. Pos/C Pos/C Pos/C Pos/C Box 6 is an example of how the impact of one adverse event may impact on the overall score, even when care is good in other components of care. Just at the point when the patient died, an inappropriate action occurred which the reviewer regarded as very unsatisfactory, although it did not contribute to the patient’s death. The reviewer gave high care scores for three phases but then deemed the overall care poor because of the adverse event at point of death. Box 6 Overall care score 1 Comment type (Pos or Neg) and category Admission Phase score 5 excellent history taking and clinical examination. Oedema of feet not recorded though is noted in subsequent ward examinations. Pos/C Neg/ B Early management Phase score 6 appropriate medical management. Decision taken to manage conservatively as end stage heart failure Pos/C Later management Phase score 6 discussion with family about end stage heart failure. Decommissioned ICD as was appropriate Pos/C Overall care Score 1 Excellent management as deemed appropriate in this terminal situation. DNR form done by team. Despite this when patient was in periarrest situation, patient was given 1 DC shock. This did not seem appropriate at all as DNR decision was discussed with the family. Pos/ C Neg/ C