End of Life Care Flashcards
What is palliative care?
palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems physical, psychosocial and spiritual
What defines end of life?
- those likely to die within next 12 months
- those with advanced, progressive, incurable conditions
- general frailty
- those at risk of dying from sudden crisis of condition
- those with life threatening conditions caused by sudden catastrophic events
What are the principles of good end of life care?
- open lines of communication
- anticipating care needs and encouraging discussion
- effective multidisciplinary team input
- symptom control
- preparing for death
- providing support for relatives before and after death
What should be discussed as part of someones end of life care plan?
- their wishes/preferences/fears
- feelings/beliefs/values that can influence choices
- who should be involved in decision making?
- emergency interventions
- preferred place of care
- religious/spiritual/personal support
- advance and anticipatory care plan
How can you formalise a patients preferences/wishes about their end of life care?
- advance statement (preferences)
- advance decision (refusals)
- power of attorney (allowing someone else to make medical decisions)
Things to consider in assessing the validity of an advance decision
- is it clearly applicable?
- when was it made?
- did the patient have capacity when it was made?
- were they coerced into making it?
- has the decision been withdrawn?
- are there more recent actions/decisions inconsistent?
What are the benefits of advance statements/decisions?
- enhances autonomy
- can improve discussions on end-of-life decisions
- avoid breaching patient’s personal/beliefs
- death with dignity
What are the disadvantages of advance statements/decisions?
- may not be valid
- may not be applicable
- attitudes may change with onset of serious illness
- may have been advances in medicine since being made
What are the 5 priorities of care of dying people?
- possibility that a person may die within next few days/hours recognised and communicated clearly, decisions made and actions taken in accordance with the person’s needs and wishes, which are regularly reviewed
- sensitive communication between staff and dying person and their close ones
- dying person and close people are involved in decisions about treatment to the extent that the dying person wants
- needs of close ones identified as important to the dying person actively explores, respected and met as far as possible
- an individual care plan including food, drink, symptom control, psychological/social/spiritual support is agreed, coordinated and delivered with compassion
Recognition of death
- observe and confirmed for minimum of 5 minutes
- apnoea; no breath sounds
after 5 minutes:
- absence of pupillary responses to light
- absence of corneal reflexes
- absence of any motor response to supra-orbital pressure
Confirmation of death
in primary care:
- absence of central pulse
- absence of heart sounds
in secondary care:
- asystole on a continuous ECG
- absence of pulsatile flow using direct intra-arterial pressure monitoring
- absence of contractile activity using echo