Palliative and End of Life Care Aims"Who provides palliative care? Palliative care can be provided by many different health and care professionals. In a hospital setting care is provided by doctors, palliative specialists, nurses and allied health professionals. In the community the palliative care team might include the person’s GP, community and aged care nurses, visiting allied health professionals, careworkers and support workers. Family, friends, neighbours and acquaintances will also provide important support."
https://diigo.com/0huchk
- Access to palliative and end of life care is available to all who can benefit fromit, regardless of age, gender, diagnosis, social group or location.
- People, their families and carers have timely and focussed conversations withappropriately skilled professionals to plan their care and support towards theend of life, and to ensure this accords with their needs and preferences.
- Communities, groups and organisations of many kinds understand theimportance of good palliative and end of life care to the well-being of society.
https://diigo.com/0hun9c
The GSF Prognostic Indicator Guidance
The National GSF Centre’s guidance for clinicians to support earlier recognition of patients nearing the end of life:
West Midlands Palliative Guidelines for Medicine:
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.
http://www.wmcares.org.uk/wmpcp/guide/Medical Goals of Care and Limitation of Treatment
The aim of the Medical Goals of Care Plan is to ensure that patients who are unlikely to benefit from medical treatment aimed at cure, receive care appropriate to their condition and are not subjected to burdensome or futile treatments. In particular, this concerns cardiopulmonary resuscitation and Medical Emergency Team (MET) calls, which may otherwise occur if the patient’s condition deteriorates. A set of Principles – Medical Goals of Care (GOC) Plan underlines this aim.
https://www.pallcaretas.org.au/medical-goals-of-care-and-limitations-of-treatment/Calm Together have put together a collection of meditations, sleep stories, exercises and music to aid relaxation and alleviate anxiety
Please select the palliative care team members involved in the care of the patient. Select all that apply. The discipline must be a regular and specifically recognized member of the palliative care team and must have contact with the patient/family. The person of that discipline may have other responsibilities but is clearly identified and identifies as a member of the palliative care team. For example, a visit by a chaplain that sees all patients in the hospital but who does not participate as a member of the palliative care team would not be included. If that chaplain did attend palliative care team meetings (clinical and administrative), then the chaplain would be considered a member of the palliative care team, and the visit would be recorded here.
Check all that apply
- Physician
- Licensed Practical Nurse (LPN)
- Chaplain/ Spiritual Care
- Dietitian/ Nutritionist
- Advanced Practice Nurse
- Psychologist
- Physical/ Occupational Therapist
- Pharmacist
- Physician Assistant (PA)
- Psychiatrist
- Other Therapist (e.g., massage, music/art)
- Community Health Worker
- Registered Nurse (RN)
- Social Worker
- Child Life Specialist
- Other: _____________________
- Symptom Management
- Decision Making (includes Goals of Care)
- Appoint health care proxy
- Providing support to patient/family
- Providing support to colleagues/staff
- Other: ____________________
Competency in Palliative Care
https://bit.ly/CompetencyinPalliativeCare
Palliative care may last for weeks, months, or years, and the relief of moderate to severe pain during that time can greatly improve quality of life. The biggest problem with palliative care is that many people are referred for care too late. By starting this type of care early, and by using the right type of pain management, nearly all pain problems can be relieved or reduced.
https://www.hopkinsmedicine.org/health/wellness-and-prevention/palliative-care-methods-for-controlling-pain
Skala Nyeri Abbey
adalah instrumen yang dirancang untuk membantu dalam penilaian nyeri
pada pasien yang tidak dapat dengan jelas mengartikulasikan kebutuhan
mereka, misalnya, pasien dengan demensia, masalah kognitif atau komunikasi.
https://www.apsoc.org.au/PDF/Publications/APS_Pain-in-RACF-2_Abbey_Pain_Scale.pdf
https://www.apsoc.org.au/PDF/Publications/APS_Pain-in-RACF-2_Abbey_Pain_Scale.pdf
Palliative care refers to the active total care of patients whose disease is not responsive to curative treatment to improve their quality of life. The main goal of palliative care is achieving the best possible quality of life. In the process of palliative care, the core activities are control of symptoms and psychological, social, and spiritual problems.
This implies palliative care is a comprehensive care to solve physical, emotional, and spiritual impact of HIV/AIDS has on a person, no matter the stage of the illness.
https://www.intechopen.com/books/palliative-care/palliative-care-in-hiv-aids
The crucial elements of palliative care in people living with HIV are the relief of pain related to physical, social, psychological, and spiritual aspects and enabling and supporting caregivers to work.
https://www.intechopen.com/books/palliative-care/palliative-care-in-hiv-aids
TRANSFORMING END OF LIFE CARE IN ACUTE HOSPITALS
The route to success in end of life care – achieving quality in acute hospitals (2010) highlighted best practice models developed by acute hospital trusts and supported by The National End of Life Care Programme (now part of NHS Improving Quality). It provided a comprehensive framework to enable acute hospitals to deliver high quality person centred care at the end of life. https://www.england.nhs.uk/wp-content/uploads/2016/01/transforming-end-of-life-care-acute-hospitals.pdf
- Level one – Palliative Care Approach: Palliative care principles should be appropriately applied by all health care professionals.
- Level two – General Palliative Care: At an intermediate level, a proportion of patients and families will benefit from the expertise of health care professionals who, although not engaged full time in palliative care, have had some additional training and experience in palliative care.
- Level three – Specialist Palliative Care: SPC services are those services whose core activity is limited to the provisional of palliative care.
Specialist Palliative Care is delivered by a multi-disciplinary team of health professionals who work together to provide care and support to the patient and family, depending on their needs and the available resources.https://diigo.com/0hueob
Maximal dose of Codein and Tramadol on WHO step 2:
Codeine 240mg/24hrs is equivalent to oral morphine 24mg/24hrs (except in the few patients who do not metabolise codeine) and tramadol 400mg/24hrs is considered equivalent to oral morphine 40mg/24hrs. The flowchart on the next page is deliberately cautious to allow safety in patients who do NOT metabolize codeine normally and are therefore less tolerant to strong opioid effects.
http://www.northerncanceralliance.nhs.uk/wp-content/uploads/2018/11/NECNXPALLIATIVEXCAREX2016-1.pdf
Hypodermoclysis (HDC) – Refers to the subcutaneous administration of fluid and electrolytes for the treatment and prevention of mild to moderate dehydration. For all other uses, the term subcutaneous therapy should be used.
Appropriate solutions for HDC are:
- • 0.9% Sodium Chloride (normal saline)
- • 0.45% Sodium Chloride (half normal saline)
- • Dextrose 5% and 0.9% Sodium Chloride (D5NS)
- • Dextrose 5% and 0.45% Sodium Chloride (D5 1/2NS)
- • Dextrose 3.33% and 0.3% Sodium Chloride (2/3 & 1/3)
- • Lactated Ringers
- • Solutions containing potassium (maximum concentration 40 mEq/litre)
Subcutaneous Hydration in Palliative Care
https://bit.ly/SubcutaneousHydrationPC
Hypodermoclysis: The continuous administration of solution, which may or may not contain medication, into subcutaneous tissue. This definition is interchangeable with ‘subcutaneous infusion’.
Subcutaneous Injection: The intermittent administration of a dose of medication directly into the subcutaneous tissue or into/via the injection site of an indwelling subcutaneous catheter.Hypodermoclysis: The continuous administration of solution, which may or may not contain medication, into subcutaneous tissue. This definition is interchangeable with ‘subcutaneous infusion’.
More than one infusion site may be used to accommodate high infusion rates.
- 1. Subcutaneous insertion sites used for medication administration should be rotated every 2-7 days and as clinically indicated.
- 2. Subcutaneous insertion sites used for hydration fluids should be rotated every 24-48 hours or after 1.5 - 2 litres of fluid and as clinically indicated.
Infusion sites include;
- a. anterior chest, upper abdomen, anterior or lateral aspects of the thigh, on the back above the scapula, and outer-upper arm;
- b. ambulatory patients – the upper chest area (subclavicular) is recommended because it allows full range of motion;
- c. patients with little subcutaneous tissue – use the upper abdomen away from the waistline. Avoid areas of constriction and areas over large underlying muscles or nerves. Low abdominal sites may cause scrotal edema. Insulin is absorbed most consistently in this site so is preferred for continuous insulin infusion;
- d. sites in the thighs may cause scrotal edema;
- e. confused patients – upper back can be useful to prevent accidental removal;
- f. skin should be intact, site located away from bony prominences and umbilical area to ensure adequate adipose tissue.
Many bereaved children are left #LostForWords by death, others simply haven’t enough words to express themselves.
Download: http://www.childhoodbereavementnetwork.org.uk/media/97729/Lost-For-Words-Benjamin-Brooks-Dutton.pdf
The following guidance must be adhered to when prescribing, dispensing or administering opioid medicines:
☛ Confirm any recent opioid dose, formulation, frequency of administration and any other analgesic prescribed for the patient.
☛ Ensure where a dose increase is intended, that the calculated dose is safe for the patient. Not normally more than 50% higher than the previous dose.
☛ Check the usual starting dose, frequency of administration, standard dosing increments, symptoms of overdose, and common side effects of that medicine and formulation.
☛ Ensure that naloxone (the antidote to opioid medicines) is available in the clinical area, to treat overdose and reverse unwanted, severe adverse effects.
☛ In palliative care and chronic opioid use give lower doses of naloxone to carefully manage opioid-induced respiratory depression and sedation, while maintaining adequate analgesia:
– 100 to 200 micrograms IV stat. If respiratory response is inadequate, give 100 micrograms every 2 minutes.
– Further doses may be necessary at one to two hour intervals especially when the opioid causing the toxicity has a long half life.
https://web.archive.org/web/20200811153615/https://mm.wirral.nhs.uk/document_uploads/guidelines/CareoftheDying-non-renal-v14_67703.pdf
Key spiritual concerns in serious illness and associated expressions
Concerns of Purpose and Meaning
Hopelessness
☛ “There is nothing left for me to live for”
Purposelessness
☛ “I feel useless”
Meaninglessness
☛ “My life is meaningless”
Loss of meaningful relationships
☛ “No one comes by anymore”
Loss of religious perspective
☛ “God has abandoned me”
Concerns of Death/Finitude
Imminent mortality
☛ “Life is being cut short”
Secondhand experience of finitude
☛ Recounting death of friends/relatives
Loss of control
☛ “I can no longer live my life the way I want to”
Concerns of Self
Loss of the self (emotionally, spiritually, religiously, physically, or in the context of a relationship)
☛ “I am not the person I used to be,” “I no longer know who I am”
Awareness of diminished sense of self
☛ “My illness took everything away from me”
https://pubmed.ncbi.nlm.nih.gov/31375189/
Ooookay kan, Bro!
