This service improvement report addresses the health inequalities experienced by individuals: Safe and Effective Quality care in Adult Nursing Assignment, KU, UK

This service improvement report addresses the health inequalities experienced by individuals with a learning disability and more specifically avoidable deaths in a National Health Service (NHS) hospital. The report focuses mainly on the completion of ‘Do Not Attempt Cardiopulmonary Resuscitation’ (DNACPR) and the concerns regarding the completion of these for individuals with a learning disability and the risks associated with this.

Concerns were identified following a review of DNACPR documentation via an audit process, professional discussions, and national awareness of avoidable deaths. The development and introduction of a specialized training package address the aforementioned area of improvement, intended to positively impact and reduce the number of incorrect DNACPRs for individuals with a learning disability. Which hopefully decreases the number of avoidable deaths of individuals with a learning disability. Consideration will be given to current learning disability awareness training that is being delivered by an acute learning disability liaison nurse within the NHS hospital in discussion.

The rationale for the service improvement is due to the continually high prevalence of avoidable deaths of individuals with a learning disability each year, despite previous recommendations and awareness of issues concerning health inequalities. These statistics are generated by annual reports, Learning from lives and deaths – People with a learning disability and autistic people (LeDeR), which review the deaths of people with a learning disability and autism.

A fishbone analysis process was utilised to specifically identify the aim for this service improvement report, as shown in figure 1a and 1b. It highlighted the area needing improvement and how achievable this was within the service. To demonstrate this was achievable, a driver diagram was used, see figure 3. Following this, a Plan-Do-Study-Act (PDSA) cycle, a known model to assess an improvement made to a service within healthcare as discussed by Katowa-Mukwato, et al., (2021) will be provided.

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