EOL Education Series

1. EOL Education Series Meeting other Needs Comfort Needs

2. Maintaining Comfort Providing comfort focused care is central to quality end of life care Maintaining comfort is the primary role of all staff attending a person in the last days of life.

3. Pathway Context A number of initial comfort measures are considered in the Pathway document (Section 2) The need for a special mattress is considered The need for a single room (if an option) is considered

4. Pathway Context The Comfort Assessment Chart nominates a number of comfort items for regular review Positioning Mouth Care Eye Care Skin Care Micturition Bowel Care Goals are stated for each Goals are documented as Met (M) or Unmet (U) Unmet goals, and the corresponding clinical response, are documented in the health record

5. Mouth care The Pathway goal is that the mouth and lips are clean and moist. This is reviewed regularly. Moist oral mucous membranes will tend to prevent thirst. Local protocols for cleaning mouth and dentures are used. Avoid alcohol based agents as these can exacerbation “dryness”

6. Positioning The Pathway goal is that a comfortable position is maintained.Frequency of repositioning is reviewed regularly (each shift). Comfort should take priority over pressure relieving interventions that cause distress. Use individual’s“preferred” position as often as reasonable. Use PRN analgesia in advance of repositioning where indicated (incident pain).

7. Eye Care The Pathway goal is that eyes are clean and moist. Eye toilets following local practice are used Eye lubrication is indicated if eye is dry eg. Liquid Tears, Viscotears gel, normal saline

8. Skin Care The Pathway goal is that skin is clean and moist. Avoid products that dry or harm skin. The need for pressure area care should be balanced against the need for comfort. Wounds should be managed in the least invasive way (no time to heal). If incontinent ensure skin protection products are used

9. Micturition Pathway goal is that the individual will be dry and comfortable. Urinary aids used if incontinent / in retention Urinary output is reduced during the last days of life Urinary retention should be excluded if individual becomes restless Catheterisation is only used where it will improve overall comfort

10. Bowel Care The Pathway goal is that the individual is not agitated or distressed by constipation or diarrhoea. Optimal bowel care prior to the last days of life, especially in the presence of regular opioids, contributes to overall comfort.

11. Bowel Care However, bowel products lessen in quantity as the end of life approaches Once oral medications are not possible, in the last days of life, bowel management agents are ceased A full rectum should be excluded if the individual becomes restless. (Use suppositories)

12. Review The Central Coast Palliative Care Service can be consulted if further advice is required

13. Bibliography Glare, P, Dickman, A & Goodman, M 2003 Symptom Control in Care of the Dying, in Care of the Dying: A pathway to excellence O’Connor, M. & Aranda, S. (Eds) 2003 Palliative Care Nursing: A Guide to Practice Wright K. 2002 Caring for the terminally ill: the district nurse's perspective. British Journal of Nursing. 11(18): 1180-5.