Aims Treatment escalation plans (TEPs) ensure patients have ceilings of care considered. They allow staff and patients to be aware of limits of treatments in the event of acute deterioration. In our NHS Trust there is currently no formal TEP document. The aims of our study were a) to evaluate the extent of current TEP decision making and documentation and b) to implement a TEP form and assess its impact.

Methods Utilising PDSA-cycle methodology, we conducted an initial survey of junior doctors and audited ward notes, looking at TEP and DNAR documentation. A TEP form was designed and implemented on these wards and doctors re-surveyed and documentation re-audited.

Results We collected data on 30 patients on three wards. 0% of patients had a TEP form. Only 10% had any TEP documentation. 47% had a DNAR decision. Survey of doctors (n=20) showed 95% thought a TEP form would make the management of patients easier. 90% of junior doctors thought everyone admitted to hospital should have a TEP. Following the implementation of the TEP form, re-audit of ward documentation (n=26) showed 60% of patients had a TEP form and 76% had a DNAR decision. Re-survey of junior doctors (n=17) showed that 100% found it beneficial in managing patients on call. 76% of respondents felt there was a reduction in inappropriate bleeps and medical emergency calls due to the introduction of the TEP form.

Conclusions The TEP form is a useful tool for facilitating ceiling of care decisions and should be considered for every patient admitted to hospital.