Advanced care planning Flashcards
what is an advanced decision?
Advanced Decision to Refuse Treatment
*legally binding
- Its purpose is to ensure that an individual can refuse a specific treatment(s) that they do not want to have in the future
What criteria must an advanced decision meet to be legally binding?
- it must be valid
- applicable and specific to medical circumstances
- over 18
- not made under influence or duress of others
- written down, signed, witnessed
what can and can’t an advanced decision cover?
- tx refused including life sustaining
- cannot refuse basic care - washing, food or drink, pain killers, tx under MHA
- cannot demand tx illegal like assisted dying
what is the main difference between an advanced statement and an advanced decision?
*advanced decision to refuse treatment is a legally binding document which needs to be written down, witnessed and signed
*advanced statement is not legally binding but is taken into account when making “best interest decisions” and can be verbal
what can advanced statements include?
- religious, spiritual views that may relate to care
- food preferences
- info about daily routine, where you would like to be cared for
- any people who you would like to be consulted when making decisions on your behalf -> NOT same as LPA
how can an advanced statement be made?
- can be verbal
- better to document
- copies given to GP, carers and relatives
What does CPR include?
CPR attempts to restart a person’s heart in the event of acardiac arrest
*It involves chest compressions, respiratory ventilation, defibrillation, and intravenous drugs
what are the outcomes of CPR?
- invasive with low success rates with less than 20% surviving
- rib #
- hypoxic brain injury
what is a DNACPR?
do not attempt CPR form
- provides information to healthcare professionals present on the best action to take if an individual suffers a cardiac arrest
what is the legal basis of a DNACPR form?
*not legally binding!!
to be so need to be recorded as an advanced decision! (well in advance of deterioration)
what are some important exceptions to a DNACPR?
- unanticipated and easily reversible cause of cardiac arrest!!
eg: anaphylaxis or choking
does a DNACPR require a patients consent?
- decision about medical treatmentmade by clinicians and therefore does not technically require patient consent
- guidance states that resuscitation should be discussed with a patient or representativebefore the form is signed and that they should be informed of the decision → GMC practise
how might you describe DNACPR to a patent or family?
- not asking for permission or consent
- explore understanding
- “As your illness progresses, you may become so unwell that your heart stops beating, this is called a cardiac arrest”
- what CPR involved and “invasive and low success rates, which may leave you with reduced QOL”
- NOT giving up, “we will keep you comfortable”
what might you prescribe for palliative pain?
- 20-30mg modified release with 5mg morphine for breakthrough pain
- oxycodone is preferred to morphine in palliative patients with mild-moderate renal impairment
how might you manage palliative secretions?
- avoid fluids and overloading
- educating family
- hyoscine hydrobromide or hyoscine butyl bromide (less sedative)
- second line glycopyrronium bromide
