An ongoing clinical quality improvement project:

One component of being a five star hospice is that Knysna Sedgefield Hospice undertakes regular audits of our performance. Why do we do this?

We want to make sure we deliver the best possible quality service to our patients and families and  keep training our staff to iron out any problems. We also need to be sure that our funders will be proud of the services that they fund and that the community has comfort that anyone referred to hospice will receive quality care.

How do we audit our performance?

  1. All patients and families are given the opportunity to complete an evaluation form

Clinical audit. This looks at  the care given to a sample of patients in a systematic scientific way. The key component of clinical audit is that performance is reviewed (or audited) to ensure that what should be done is being done, and if not it provides a framework to enable improvements to be made.

  1. The clinical audit which has been used by Knysna Sedgefield hospice annually since 2008 is known as APCA POS. This is an acronym for African Palliative Care Association Patient Outcome Scale.

Clinical audit using APCA POS

The benefits of this quality improvement programme are:

  • Improved care to patients and family members
  • Documented evidence of the impact of the palliative care service
  • Demonstrate effectiveness of care and motivate for expansion of the service.
  • Evidence of the effectiveness of palliative care as a discipline.
  • Evidence to convince funders and policy makers of the impact of palliative

The development of the APCA POS

The Palliative Outcome Scale (POS) is a brief  set of 10 questiions used in the care, audit and evaluation of palliative patients. The same 10 questions are used in 6 consecutive visits to the patient and family. Seven questions apply to the symptoms of the patient and 3 to the coping of the family. The palliative outcome scale was , developed at the King’s College, London (KCL) (Hearn & Higginson Quality in Health Care 1999). It has since been validated and adopted in 14 countries: Argentine, Cuba, across Europe and the US and Saudi Arabia.

During 2005 – 2006 a collaboration between KCL, the National Hospice Palliative Care Organisation (NHPCO) in the USA and the African Palliative Care Association Africa validated the POS for use in the African setting. This questionnaire is registered as the APCA POS.

Ethical considerations

In conducting this service evaluation, we need to achieve a balance between protecting interests of vulnerable participants & valuably expanding the research base in palliative care. In order to avoid bias, the researcher is not a member of the clinical team.

We do believe that it is important to conduct research or clinical audit with the aim of improving our service for patients who are seriously ill as well as for any other health care user. We believe that there is direct therapeutic benefit for participants, of better patient outcomes. Indirect benefits include the patient’s sense of being valued and of making a difference themselves in contributing to research and audit and the appropriate expansion of services.

We thank  our patients and families who have been willing to participate in this clinical audit. They have contributed to one of our strategies for monitoring the quality of service we deliver and of which we want to continue to be proud.