Electronic Proactive Assessment and Information Guide for End of Life (EPaige)

Community Blue Booklet Audit 2020- Headlines for GP’s and Community Nurses

An Audit of the ‘Blue Booklet’

  • The ‘Blue Booklet’ is used in East and South Cheshire and Vale Royal in the community setting.
  • It enables the authorisation and administration of symptom control medications for patients in the last days of life.
  • An audit was carried out of 29 booklets that were in use across East Cheshire during August and September 2019.
  • Positive findings
    • The Blue Booklet was being used for the correct group of patients – it was in situ in a patient’s home, on average, for 8 days prior to the medication being required.
    • The dose ranges of both PRN and Syringe pump medications were appropriate and within guidelines
  • Areas to improve
    • Prescriber information (front page) was only completed in around half of booklets audited. Therefore it is not always clear who has prescribed the medications. In one instance this has led to a delay in medications being administered whilst nursing staff verify the document with medical team.
    • Allergies (front page) only recorded in around half the booklets audited
    • PRN frequency of opiate only written in half of the booklets audited – patients may be receiving doses too frequently or not frequently enough!
    • Only 12 patients with booklets in their home had a documented discussion (on EMIS) about the use of the blue booklet. Ineffective communication with patients at end of life and their families is a common cause of complaints and ongoing concerns for bereaved relatives.
  • Next Steps
    • The Blue Booklet will be reviewed and updated in 2021
    • The results from this audit will be used to improve this document for its users.
    • Any comments or questions please contact The East Cheshire Palliative Care Team ecn-tr.palliativecareteam@nhs.net or the End of Life Partnership info@eolp.org.uk