Bone Marrow Failure and Chemotherapy Flashcards
why is it important to identify dying patients?
advanced care planning, they want to know, plan finances, say goodbye, ensure loved ones are prepared
what can be used to try and identify dying patients?
GSF, RCP, SPICT
what factors is it important to consider when assessing dying patients?
Advanced, progressive, incurable condition
General frailty and coexisting conditions (expected to die in next year)
Existing condition where they are at risk of dying from sudden acute crisis
Life threatening acute condition caused by sudden catastorophic event (PE
what is advanced care planning?
A process of discussion between an individual and their care providers (may be family or friends)
Facititates and enables individuals to think about the care they would like to receive
what is the SPICT tool?
Guide to identify people at risk of death in next year
Looks at genera indicators for deteriorating health as well as indicators of specific diseases
what are the general indicators of poor health looked for using the SPICT tool?
- unplanned hospital admission
- performance status poor or deteriorating
- depends onothers for care
- significant weight loss
- persistent symptoms despite treatment
- patient or family asks for palliative care
what are the features of advanced care planning?
Step by step approach Process not a singe event Patient needs to be ready Comfortable, unhurried surroundings Appropriate documentation Information sharing with team and GP (DNACPR and preferred place of care
why is advanced care planning important
Most people (85%) don’t die suddenly-after chronic illness
50% are not in a position to make their own decisions when close to death
A doctor who is uncertain about what to do and who has to make a decision will often treat aggressively
Many kept alive under circumstances that they wouldn’t want
what are the aims of advanced care planning
aim to improve planning
Improved symptom control
Better end of life decision making (withholding treatment)
Decision to reduce active treatments and resuscitation even if deemed medically appropriate
Discussions around place of care/death
what are the important things to consider in a progressive illness in an acute setting for a dying patient?
Advanced care planning AMBER care bundle DNACPR Escalation ceilings PPC Pre-emptive prescribing Rapid discharge Home to die EoL care plan
what symptoms can be expected in a patient at end of life?
Pain. Respiratory tract secretions, restlessness and agitation, delirium, dyspnea, emesis
describe the prescription of drugs in end of life care?
Drugs prescribed preemptively in last weeks of life
Drugs – antimuscarininc, opioid, antipsychotic, benxodiazepine,
when are anticipatory drugs prescribed
When patient cant swallow
When near end of life
When patient might not be able to swallow soon
describe the role of anticipatory prescribing?
May be needed for symptom management Symptoms might not be present yet Might bot be able to swallow Needed at home, hospital or hospice Not definitive treatment just to aid comfort
how should anticipatory drugs be administered in cachexic patients?
not give IM injections-use subcutaneous route
as well as anticipatory prescribing, what other action should be taken?
Avoid unnecessary interventions such as observations, investigations, assess fluids when necessary, DNACPR
Discontinue unnecessary medication (steroids, antibiotics, hormones, antidepressants, diabetic drugs (not type 1), cardiovascular drugs/statins, vitamins/iron, prophylactic LMWH)
describe prescription of anticipatory medication in patients not currently taking any pain medication?
- diamorphine s/c injection 1.25mg-2.5mg (1-2 hourly)
- if 2-3PRN needed-syringe driver. diamorphine 5-10mg s/c over 24 hours
- reassess every 24 hours
describe prescription of anticipatory pain medication in patients already taking oral morphine?
- convert oral morphine to diamorphine s/c (24 hour dose of morphine divided by 3
- also prescribe prn diamorphine s/c for breakthrough pain (1/6 dose in driver)
- reassess every 24 hours
describe prescription of anticipatory pain medication in patients already on fentanyl?
- maintain fentanyl patch and prescribe diamorhpine s/c prn in anticipation of breakthrough pain. (calculate fentanyl patch by 5)
- if 2-3prn doses needed in 24h, commence diamorphine s/c via syringe driver over 24 hours
- reassess every 24 hours
what are the common indications for syringe driver?
Persistent nausea and vomiting
Severe dysphagia