End of Life Care Planning

1. End of Life Care Planning Rita Gallagher NewparkCare Centre 21-03-2014

2. End of Life Care planning The end of life of phase ‘applies to people with a variety conditions and involves a longer time period than the days or weeks immediately before death.( NCAOP 2008)

3. End of life care planning ‘care that helps all those with advanced, progressive, incurable illness to live as well as possible until they die’ • e.g. those with Dementia, Recurrent repeat infections, exacerbation of chronic illness • The NHS (2007)defines EOLC as

4. End of life care planning • This enables supportive, palliative care needs of both the resident and their family to be identified and met throughout the last phase of life and into bereavement. It includes management of pain and other symptoms plus the provision of psychological, social and practical support

5. End of life care planning • Physician Orders for Life-Sustaining Treatment • POLST

7. End of life care planning • Nursing Homes Nursing Projects • In association with Dr S. Kennelly -Inappropriate presentations at A&E -EOLC Trial of Regina Mc Quillan, initial work on EOLC and POLST type document, we adapted it slightly before we adopted it.

8. Name: _______________________________ NEWPARK CARE CENTRE / Address: _____________________________ GUIDELINES FOR PATIENTS Date of Birth: ________________________ RESIDENT IN /RETURNING TO NURSING HOME FOR M.R.N Number: ______________________ SUPPORTIVE - COMFORT CARE (if in hospital) These are guidelines for the medical/ nursing team based on the patient ’ s medical condition and wishes. A COPY SHOULD BE KEPT IN THE PATIENT ’ S MEDI CAL RECORDS IN THE HOSPITAL AND IN THE NURSING HOME and should accompany patient when transferred . This document should be discussed with patient/family, nursing home manager and GP prior to transfer if patient is being discharged from hospital. THIS IS NO T A TICK EXERCISE BOX Name of GP/ Medical Officer with whom this plan discussed Name of Director of Nursing / Clinical Nurse Manager with whom this plan disc ussed Name/s of family members with whom this plan discussed The basis for these orders is: o Patient’s preferences ¨ Patient’s best interest CARDIOPULMONARY RESUSCITATION (CPR): Person has no pulse and is not breathing. Section A ¨ Attempt Resuscitate (CPR) o Do Not Attempt Resuscitation (no CPR) Check One Box If DNR, letter for ambulance crew Only When not in cardiopulmonary arrest, follow B, C and D MEDICAL INTERV ENTIONS: Section Comfort measures Treat with dignity and respect ¨ B Use medication by any route, positioning, wound care and other measures to relieve pain and suffering. Refer Check to Section C re antibiotic care plan. Use oxygen, suction and manual treatment o f airway obstruction as needed One Box Do not transfer to hospital for life – sustaining for comfort. Refer to Section D for nutrition and fluid plan. Only treatment. Transfer only if comfort needs cannot be met in current location. Limited Additional Interventions o Includes care described above. Use medical treatment. Refer to Section C re antibiotic care plan. Refer to Section D for nutrition and fluid plan. Do not use intubation, advanced airway interventions, or mechanical ventilation. Transfer to hospital if indicated. Avoid intensive care Full Treatment ¨ Includes care above. Use intubation, advanced airway interventions, mechanical ventilation, and cardioversion as indicated. Transfer to hospital is indicated. Include intensive care. Other instruction s:_______________________________________________

9. End of life care planning discussions in that regard can be complex , lengthy and make take more than 1 conversation ! Guidelines for use: • ALWAYS try to ascertain the views of resident • Decisions re personal health rest primarily with the resident AND medical team ONLY • Family collaboration is important • GP involvement essential COMMUNICATION IS KEY

10. Important that these discussion around EOLC are made at senior staff level- • Residents MUST be made aware that there are occasions where transfer to hospital would be in their best interests e.g fracture • The EOLC document is photocopied and travels with the resident • Anticipatory medications are written up by GP • Document • Reviewusually 3/12

11. And you might think its all over/Done Be prepared! you may have to revisit • WHY ? • Listening to resident- • Rationale for discussion • appropriate treatments • Complex conversations • Clear communication between everyone involved • Support

12. End of life care planning • This document is not stand alone and MUST be used in conjunction with care planning. • Care plans should include details of residents wishes on EOLC • Wishes and expectations if they become unwell • Views on transfers to hospital • All staff must be aware of their wishes • Family must be aware • COMMNICATION IS KEY • Good robust documentation is important

13. End of life care planning • In 2012 there were 17 deaths in my facility • 15 had EOLC plans in place • Those 15 were cared for in the nursing home and passed away there • 1 was a respite who became unwell and died in nursing home • 1 suffered a trauma and was transferred to hospital where they passed away • This process takes a lot of time , good rapport with GP, knowledge of the resident and their condition, getting to know resident and family ,family dynamics and being confident in the care your facility can deliver.

14. End of life care planning • Of interest perhaps adapted from Australian aged care (Queensland Government) • Adapted from Residential Aged Care end of Life Care Pathway • Comfort care plan docs-Instructions for completing Pathway • Very useful for monitoring care when a resident is very ill • They assist with decision making process • Ensure there is a clear rationale for administering medication (anticipatory) • Is excellent at tracking care for nurses -at change of shifts- for other allied health care staff –gp, and the likes of me DON

16. Comfort Care Document

17. End of life care planning • Thank you • Any Questions ?