As NICE highlights in its new guidelines, there were three main areas of concern:
The decision that a person was dying was not always supported by an experienced clinician and not reliably reviewed, even if the person may have had potential to improve.
The dying person may have been unduly sedated as a result of inappropriately prescribed medication.
Concerns that hydration and some essential medicines may have been withheld or withdrawn, resulting in a negative effect on the dying person.
https://www.nhs.uk/news/medical-practice/new-guidelines-on-end-of-life-care-published-by-nice/
These guidelines are one of many resources available to health care professionals in Fraser Health to improve health care outcomes in hospice palliative/end-of-life care. These guidelines provide recommendations based on scientific evidence and expert clinical opinion.
https://www.fraserhealth.ca/employees/clinical-resources/hospice-palliative-care#.Xgp5-hsxXZ6
STROKE AND PALLIATIVE CARE
https://sites.google.com/view/stroke-and-palliative-care/home
Stroke symptoms can include:
paralysis
numbness or weakness in the arm, face, and leg, especially on one side of the body
trouble speaking or understanding speech
confusion
slurring speech
vision problems, such as trouble seeing in one or both eyes with vision blackened or blurred, or double vision
trouble walking
loss of balance or coordination
dizziness
severe, sudden headache with an unknown cause
nausea or vomiting
hallucination
pain
general weakness
shortness of breath or trouble breathing
fainting or losing consciousness
seizures
confusion, disorientation, or lack of responsiveness
sudden behavioral changes, especially increased agitation
https://www.healthline.com/health/stroke#symptoms-in-women
All people admitted to hospital with Acute stroke should receive:
Swallow screen
modification of diet or institution of NG feeding as appropriate within 48 hours
Hydration Status: Maintain euvolemia.
Assessment of continence
Evaluation of pressure risk
Early mobilisation where appropriate
Occupational therapy and seating assessment
Multidisciplinary assessment and discussion
Assessment of mood
Information meeting with relatives and patient
Source:
Care of dying adults in the last days of life NICE guideline [NG31] Published date: December 2015
https://www.nice.org.uk/guidance/ng31
PALLIATIVE CARE IN HOSPITALS - AN OVERVIEW
Baca dulu!
SG Pall Ebook
https://www.duke-nus.edu.sg/lcpc/resources/sg-pall-ebook-disclaimer
Opioid use in palliative care: new developments and guidelines
https://www.prescriber.co.uk/article/opioid-use-in-palliative-care-new-developments-and-guidelines/
ESMO guidelines note that although oral administration is advocated, patients presenting with severe pain that needs urgent relief should be treated and titrated with parenteral opioids, usually subcutaneous or intravenous.
https://emedicine.medscape.com/article/2500043-overview#showall
Guideline PC
These guidelines are a summary of the current practice of specialists working in palliative care in the West Midlands Region and can be used for patients who are receiving care at home or in hospitals. Your local Specialist Palliative Care Team are available for further advice. The production of these guidelines is independent, funded by the sales of previous editions
http://www.wmcares.org.uk/wmpcp/guide/
INCTR Palliative Care Handbook:
This site is an electronic version of the INCTR Palliative Care Handbook. It is freely available in this format, and can be purchased as a robust hard copy pocket version for all who need information on symptom control in patients with serious diseases.
http://inctr-palliative-care-handbook.wikidot.com/table-of-contents
Scottish Palliative Care Guidelines
The Scottish Palliative Care Guidelines reflect a consensus of opinion about good practice in the management of adult patients with life-limiting illness. They are designed for healthcare professionals from any care setting who are involved in supporting people with a palliative life-limiting condition.
https://www.palliativecareguidelines.scot.nhs.uk/guidelines/symptom-control.aspx
iPal
Access to key information about palliative care:
Assess: screening tool to assess need for palliative care and symptom assessment scale and tips.
Manage: drugs and other therapies for common symptoms
Plan: aids for planning future care and decision-making
Communicate: make communication therapeutic by using talking tips for breaking bad news, CPR, prognosis, goals of care, end-of-life and specific situations
BERKSHIRE ADULT PALLIATIVE CARE GUIDELINES - END OF LIFE CARE – GL110
Palliative care helps people live as fully and as comfortably as possible with a life-limiting illness. Palliative care is for people of any age. It can be provided in your home, a hospital, a hospice or an aged care (nursing) home.
https://www.health.gov.au/health-topics/palliative-care
Palliative Performance Scale Population: https://eprognosis.ucsf.edu/pps.php
PALLIATIVE CARE IN DEVELOPING COUNTRIES - PRINCIPLES AND PRACTICE
From our experience at the hospice we know that organ/tissue donation can help patients and families feel comforted by knowing that they have given hope to others, and that some good has come out of their loss. However, we also realise that not everyone feels comfortable with taking such a step.
https://www.stchristophers.org.uk/wp-content/uploads/2015/11/CORNEA_and_TISSUE.pdf
THE IAHPC MANUAL OF PALLIATIVE CARE 3RD EDITION
IAHPC List of Essential Practices in Palliative Care
Evidence-based resources for assessing pain, symptom burden, psychological and social needs, caregiver burden, and spiritual distress.
https://www.capc.org/toolkits/patient-identification-and-assessment/
Access to key information about palliative care:
Hospice patients can experience many kinds of symptoms such as: pain, restlessness/agitation, confusion/delirium, lethargy/weakness, shortness of breath, and nausea/vomiting.
https://www.hopewestco.org/managing-common-symptoms/
Puan, is a name of my cat.
SKILLED AND COMPASSIONATE COMMUNICATION
‘‘Skilled and compassionate communication
by the nurse can help place the patient
back at the center of the [important] decision[s],’’
by facilitating advanced directive completion
or in the absence of a directive,
ensure that the patient’s,
surrogate’s,
or health care agent’s
wishes are met.
A nurse can understand a patient’s wishes
by understanding the following:
☛ What are the patient’s values and goals?
☛ What would the patient want if he/she could speak for
☛ themselves?
☛ What is possible?
☛ How has the patient lived their life?
☛ What constitutes good medical care for the patient?
Key constructs of effective communication
at the family conference
- Recognise the importance of uncertainty.
- Use appropriate language in the family conference — avoid “withdraw care” and “nothing more we can do”.
- Avoid discussion of odds. Families latch on to and concentrate on the given figure. When the risk of death is high and a treatment option is low-risk, it may be perceived as acceptable in spite of potential suffering.
- Provide familiar faces at family conferences and consistent information delivery. If rostering means the discussion leader is to leave, the family should be formally handed over to the new discussion leader and other participants such as nurses encouraged to continue attending.
- Earn trust by the family seeing the way the staff interact with each other and how they speak to and care for the patients.
- Explain early that the goal of treatment is to return the patient to health and if this is not possible alternatives need discussion.
- Give families written material regarding end-of-life care and intensive care management.
- Present prognosis as in terms of practical certainty — “we are as certain as we can be”.
- Encourage second opinions.
- Involve known supporters (eg, religious leaders/family doctors).
PALLIATIVE CARE COMMUNICATION GOALS
The goals of palliative care communication are as follows:
☛ Rapport building
☛ Communication support
☛ Exploring concerns
☛ Determining family spokesperson
☛ Describing operating room setting
☛ Describing expected process of dying
☛ Delineating process in operating room
☛ Describing what will happen when patient is not deemed a donor
☛ Hospice/palliative care planning
Eric Prommer
JOURNAL OF PALLIATIVE MEDICINE
Volume 17, Number 3, 2014
DOI: 10.1089/jpm.2013.0375
https://www.liebertpub.com/doi/full/10.1089/jpm.2013.0375
GOALS OF COMMUNICATION AT THE END OF LIFE
- Convey respect and understanding for the patient as a person first, patient second
- Convey information about illness, its likely course and treatment options (including resuscitation, life support and artificial nutrition)*
- Communicate empathy and support
- Convey appropriate hope**
- Develop a treatment plan in context of patient’s goals, values and notions of quality of life
- Arrange for follow up meetings and reassure about ongoing care and support
COMMUNICATION AT THE END OF LIFE
https://pharmacopallcare.blogspot.com/2020/09/communication-at-end-of-life-ika.html
INTERPROFESSIONAL TEAM
Palliative care is delivered
by an interprofessional team.
This team can consist of
health care professionals
with or without a university degree.
Depending on the needs
of the patient and his or her attachment figures,
other professionals
with a background in social sciences
or psychology,
pastoral care
or other occupations are included.
Volunteers can be part
of the interprofessional team
and of the palliative care,
taking into account their qualifications
and responsibilities.
The specialists of the interprofessional team,
the assistant staff
as well as the volunteers
require training
and/or (internal) further
or continuing education
(primary care providers and specialists)
geared towards their assignment
in the delivery
of palliative care.
Hospice care is appropriate any time after a doctor has estimated that a patient has six months or less left to live, and both doctor and patient have decided to move from active curative treatment to a regimen more focussed on quality of life.https://www.hospicesect.org/hospice-and-palliative-care/stages-of-hospice-care
PALLIATIVE CARE IN FRAILTY
Recommendations for palliative care in frailty:
- ☛ Recognise the absence of clear thresholds for initiating palliative care in patients with frailty.
- ☛ Periodically assess and quantify frailty burden in one way or another, for example, with a frailty instrument or geriatric assessment.
- ☛ Periodically assess healthcare needs as triggers for initiating a palliative care approach.
- ☛ Incorporate evaluation of cognition in all palliative care assessment for older or frail patients.
- ☛ Consider the possibility of undertreated symptoms in case of behavioural issues in patients with dementia.
- ☛ Utilise healthcare crises, hospital admissions or admission to long-term care as time-out moments for advance care planning discussions.
- ☛ Discuss advance care planning in light of all of the patient’s comorbidities and impairment rather than from a single disease perspective.
- ☛ Consider medication and comorbidities as explanations for symptoms requiring palliative intervention.
- ☛ Discontinue ineffective, poorly tolerated and duplicated medications.
- ☛ When treating symptoms, start low, go slow and keep going until adequate symptom control is achieved.
- ☛ Assess falls risk and initiate targeted interventions.
- ☛ Utilise the expertise and experience of both geriatric and palliative care specialists in the care for older patients with frailty.
https://spcare.bmj.com/content/10/3/262
Reducing readmissions is currently part of a national strategy to reduce health care costs, the main target being 30-day readmission rates. Palliative care programs help to reduce readmissions by 50%, increase referrals to hospice, decrease stress to caregivers, and lower overall health care costs. Palliative care programs do not increase hospital mortality rates because mature programs are better than the standard of care at getting people home and preventing those admissions that are intended solely to allow the patient to die in the hospital .
https://pubmed.ncbi.nlm.nih.gov/24641562/
Okay kan, Bro!
IKA SYAMSUL HUDA MZ
