A6 Care of the dying Flashcards
what do we mean by end of life care?
- involves treatment, care and support for people who are nearing the end of their life
- support for people in the last months of their life
- holistic approach to patient care
end of life care must be:
- compasisonate
- tailored to the person’s needs, wishes and preferences
- regular and effective communication
- delivered with high standards, skills, knowledge and experience
how does care shift in end of life care?
- shifts from active treatment to symptom management
how should patients be able to act during end of life care?
- have the right to decisions regarding what further care is appropriate eg. DNR
- encouraged to have these conversations in advance of end of life care
pharmacist role in end of life care
- deprescribing / medicine rationalisation
- supply of anticipatory medicines (just in case)
- advice on dose conversion with route changing
- guidance and support on syringe driver compatibility
what is a syringe driver? what is the pharmacist’s role with these?
- a device that can release a mixture of drugs into the skin over period of 24 hours
- pharmacist has a role of telling the patient what can be mixed and at what quantities
what are the 4 principles of medicines optimisation in palliative care?
- aim to understand the patient’s experience
- evidence-based choice of medicines
- ensure medicines use is as safe as possible
- make medicines optimisation part of routine practice
what is medicine rationalisation? how should a pharmacist act when performing this?
- ‘the process of withdrawing drugs to try to improve outcomes’
- work sensitively with the patient and their loved ones to reduce panic
describe the use of anticipatory medicines and what they are
- ‘enable prompt symptom relief at whatever time the patient develops distressing symptoms’
- medicines supplied in advance of a patient needing them so they are ready for exactly when they are needed
how is an anticipatory medicines plan made?
- a plan is made based on current management and current requirements
- whilst all care is tailored, we can predict the most common symptoms that patients experience as they are ending their life
how is pain managed when it comes to symptom management in end of life care?
- by the clock, by the mouth, by the ladder (start gradually and build up)
- codeine or morphine can be used
what symptoms may need to be managed in end of life care?
- pain
- restlessness / agitation
- secretions in the chest (sounds raspy, ‘death rattle’)
- nausea and vomiting
- breathlessness
- support hydration in the last days of life
what drug may be used to manage restlessness / agitation in end of life care?
midazolam
explain the reasoning for nausea and vomiting during end of life care
- may be due to the opioids used for pain (they’re notorious for making people feel sick and constipated - laxatives may be needed)
how can nausea and vomiting be managed in end of life care?
- oral antiemetics
- eg. cyclizine, metoclopramide, levomepromazine (this one can also be subcutaneous)
how can hydration be supported in end of life care?
- artificial saliva
- chew on ice chips
- pineapple chunks can help stimulate saliva production
