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‘Mouth matters in palliative care’

‘Mouth matters in palliative care’. Hilton Doubletree, Dundee 1 October 2015 Elaine MacLean, Palliative Care Adviser, within the Health Improvement Team.

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‘Mouth matters in palliative care’

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  1. ‘Mouth matters in palliative care’ Hilton Doubletree, Dundee 1 October 2015 Elaine MacLean, Palliative Care Adviser, within the Health Improvement Team

  2. 2015 Scottish funding in place for a new ‘Strategic Framework for Action for Palliative and End of Life Care’ aiming to be published in the later this year

  3. Palliative care • Life limiting illness, can be constantly progressing - well one day, then condition can change quite suddenly • Carers are in a unique position because they spend longer periods of time with the person can observe changes or symptoms “It is natural to die as to be born Francis Bacon (1561-1626) British statesman and philosopher”

  4. End of life care • Guidance by NHS Scotland (December 2014) target audience health and social care • Caring for people in the last days and hours of life • The ‘Guidance and its 4 principles’ shall be the ‘Framework’ for end of life care for further planning and development at a local level across Scotland

  5. Section 1: Principles 3. Each person’s physical, psychological, social and spiritual needs are recognised and addressed as far as possible • agreed goals of care should be documented and reviewed at least daily • preferred place of care • discussions should be documented from meetings • symptoms should be assessed & intervention recorded • seek help from specialist palliative care • religious and spiritual needs to be identified

  6. Section 2: Three Specific Areas of Importance 2.1 Hydration and / or Nutrition • Always review / good mouth care essential / reasons for decisions or changes need to be explained to the family and carers 2.2 Recognising the uncertainty of a diagnosis of dying 2.3 Communication with people and families and between staff www.gov.scot/Publications/2014/12/6639

  7. Scottish Palliative Care Guidelines • Oral health care guideline • Healthcare Improvement Scotland and Scottish Partnership for Palliative Care • http://www.palliativecareguidelines.scot.nhs.uk/

  8. Mouth matters: • Dry mouth • Side effect of treatment? • Side effect of medication? • Breathing through the mouth when breathless? • Poor fluid intake?

  9. Palliative care approach: • Ask if the person is having problems – how does their mouth feel? • Observe • Consider drug history – some drugs can cause dryness • Daily oral inspection as part of care?

  10. Mouth matters: • Mouth ulcers • Check dentures are they rubbing / food trapped • Consider if there has been weight loss • Badly fitting dentures - may need to be realigned

  11. Mouth matters: • Thrush (candida) • White patches on the side of the mouth • Or tongue red and glossy • May occur in people who are diabetic, people on steroids, or taking antibiotics

  12. Infections • Fungal infection e.g candidiasis • Viral infection e.g. herpes simplex • Reassure the person and family • Provide explanation of symptom and how you are going to help

  13. Mouth care for people with palliative care needs • Key principles • Assess • Plan regular effective mouth care • Confidence to refer • Identify urgent referrals • For people at home: • If person on chemotherapy or radiotherapy they need careful monitoring pre and post treatment • Maybe salivary gland dysfunction or mucosal changes

  14. At end of life: • All about the person • Key areas are observation for appearance of lips – dry? cracked? • Breath – bad? • Dry mouth, making it difficult to speak? • Difficulty swallowing?

  15. How to help at the right time • At end of life – keep mouth moistened • Frequent mouth care • Explain process to family • Reassure the person and the family • Be aware of your own feelings “At my age I do what Mark Twain did. I get my daily paper, look at the obituaries page and if I’m not there I carry on as usual. Patrick Moore (1923 - 2012) British astronomer and TV presenter”

  16. Symptom management • Consider why person is in pain? • Tooth decay / ulcer / bite • Seek dental opinion • Oral mucositis • Persistent pain - seek medical advice • www.nhsinform.co.uk/palliativecare/symptomcontrol/mouthcare

  17. RCN Guide Getting it right every time • Fundamentals of nursing care at end of life • The seven Ps • On which one is – Provide – good mouth care regularly, whether eating and drinking or not • www.rcnendoflife.org.uk • www.rcneolnutritionhydration.org.uk

  18. Web links: • Palliative care course information –with revised ACP facilitators pack on the ACP toolkit section of the website www.palliativecareinpractice.nes.scot.nhs.uk Quotes in slides from Public health and death & dying in England • www.dyingmatters.org/ • www.goodlifedeathgrief.org.uk

  19. Web information on palliative and end of life care • 1) Information for patients and families NHS inform have a palliative care zone: • www.nhsinform.co.uk/PalliativeCare • 2) The bereavement zone on NHS inform: • www.nhsinform.co.uk/bereavement • 3) SPICT Tool (prognostic indicator) • http://www.spict.org.uk/

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