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The Last Days - the Essentials

The Last Days - the Essentials. Dr Mary Kiely Consultant in Palliative Medicine CHfT. Important facts. Presumption made that PPD is home Public’s lack of familiarity with dying Family’s preparedness Commitment from PHCT Forward planning and anticipatory care. Equipment 1.

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The Last Days - the Essentials

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  1. The Last Days - the Essentials Dr Mary Kiely Consultant in Palliative Medicine CHfT

  2. Important facts • Presumption made that PPD is home • Public’s lack of familiarity with dying • Family’s preparedness • Commitment from PHCT • Forward planning and anticipatory care

  3. Equipment 1 • Hospital bed/profiling mattress • Cantilever table • Glideabout commode/catheter • Recliner chair • Baby alarm • (Dark green towels)

  4. Equipment 2 • Extra pillows and bed linen • Wet wipes • Plastic box • Fan • Syringes/mouth care sponge sticks

  5. Drugs - opioids • Which drug/route, conversion ratios, daily dose AND prns • Reduction in EGFR leads to reduction in opioid requirement • Beware oxycodone availability

  6. Drugs - opioids • What to do with the fentanyl patch • Zomorph to diamorphine • OxyContin to oxycodone

  7. Drugs - midazolam • Anxiolytic at 10mg/24hrs • Sedative at 20mg/24hrs • Anti-convulsant at 30mg/24hrs • Augments effect of opioids • Renally excreted • Maximum dose 80mg/24hrs

  8. Drugs - haloperidol • Anti-emetic (D2 antagonist) for chemical nausea - uraemia, hypercalcaemia, cytokines, etc • Doubles as anti-psychotic • Dose range 2.5-10mg/24hrs • Accumulates in liver failure

  9. Drugs - Buscopan • Anti-secretory and anti-spasmodic • Doesn’t cross blood-brain-barrier • Maximum dose 120mg/24hrs for death rattle; 300mg/24hrs for colic • Incompatible with cyclizine

  10. Other drugs • Ketorolac • Alfentanil • Levomepromazine • Octreotide • Remember water for injection (saline for ketorolac)

  11. Preparedness • Palliative Care Handover form to NHSD • Region-wide DNACPR form • Your willingness to reassess and revisit • Requirements for death certification • Wishes re corneal donation

  12. Stuff to tell the family • Explain the DNACPR form • Explain OOHs’ services • Dying can take time/role of self care • Physiological changes • Explicit discussion about lack of food/fluids • What to do when the patient dies

  13. Remember! • Vital role of district nurses • Joint assessments with CNS • Out of hours’ advice from Consultants and SPC staff 24/7 • Look after yourself

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