Introduction and Objectives A Treatment Escalation Plan (TEP) is a communication tool designed to improve quality of care for the deteriorating inpatient. TEPs aim to reduce variation caused by discontinuity of care, avoid harm from inappropriate treatment and promote patients’ priorities and preferences.

Despite evidence in favour of TEP use and regular morbidity and mortality (M&M) data demonstrating the case for TEPs in our 112-bedded respiratory unit, engagement with treatment escalation planning was consistently low. Our goal was to increase clinician confidence in using TEP forms and create a culture where TEP is a normalised part of the respiratory patient pathway, improving quality of care.

Methods We implemented a series of educational interventions at departmental and directorate level and made TEPs more visible/accessible on the respiratory unit. We also recruited ward managers, nurse specialists and junior clinical staff as ‘TEP Reps’ to regularly advocate for TEP use.

PDSA cycles were carried out with monthly re-audit of TEP use following each intervention.

Results Consistent improvement in TEP use was demonstrated across the respiratory unit (see figure 1). Baseline data December 2022 showed that, of those meeting criteria for consideration of TEP (as outlined on the healthboard TEP proforma) only 6% of patients had documented TEPs. By the end of PDSA cycle 5 in May 2023 this improved to 39%, sustained at 34% at 6 months. Qualitative data suggests a growing TEP culture amongst clinicians with increased awareness of TEP forms and confidence in OOH care delivery. Qualitative data about patient experiences of TEP conversations is awaited. M&M data review showed that TEP use in the deceased respiratory inpatient population had increased from 25% December 2022 to 32% March 2023 (M&M data July 2023 awaited).

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Abstract M7 Figure 1

Conclusion We have demonstrated that TEPs can be incorporated into respiratory inpatient care, improving clinician confidence in management of the deteriorating respiratory patient.

Reference

1. Taylor DR, Lightbody CJ, Venn R, Ireland AJ. Responding to the deteriorating patient: the rationale for treatment escalation plans. Journal of the Royal College of Physicians of Edinburgh. 2022;52(2):172–179. doi:10.1177/14782715221103390