Palliative Care Flashcards
What is the Amber care bundle (ACB)?
AMBER = Assessment, management, best practice, engagement and recovery uncertain
Employed for patients in whom recovery is uncertain - used to structure and manage necessary End of Life agreements that need to be put in place
Amber care bundle screening questions
1) is patient deteriorating / clinically unstable / with limited recovery
2) Is patient at risk of dying in the next 1-2 months
If YES to BOTH —> ACB
Within the ACB - what should you do with the patient
Formulate EoL planning
Advanced care planning (ACP) - Advanced decision to refuse treatment (ADRT) and DNA-CPR
Register on the Gold Standards Framework (GSF)
What are the symptoms of death?
Death rattle / secretions Pain agitation and restlessness Confusion N+V Urinary dysfunction
What the anticipatory medicines
Analgesia - Morphine/Diamorphine
Anti-secretory - hyoscine butylbromide / hydrobromide
Anxiolytic - Midazolam
Anti-emetic - Haloperidol / cyclizine, levomepromazine
What are the common morphine drug conversions?
Morphine PO –> Diamorphine S/C = divide by 3
Morphine PO –> Morphine S/C = divide by 2
Morphine PO –> Diamorphine PO = divide by 2
Dose of Haloperidol?
1.5 - 3mg, STAT, or 3-10 mg/24hrs
Dose of Anti-secretory medicines?
Hyoscine butylbromide - 20mg S/C, 60-120 mg/24 hrs
Hyoscine Hydrobromide - 400mcg STAT, or 1.2-1.4 mg/24hrs
Dose of midazolam?
2.5 - 5mg, S/C 60mg Max (frequency Hourly)
How is death confirmed?
Confirm absence of mechanical cardiac function for 5 MINUTES
- absence of central pulse on palpation
- absence of heart sounds on auscultation
Confirm absence of:
- pupillary response to light
- corneal reflexes
- any motor response to supra-orbital pressure
Time of death is when these criteria have been fulfilled
Who can complete a death certificate?
Doctor attending the deceased during their last illness
Must have seen the patient within the last 14 days
Must fill out certificate within 24hrs of death
How to fill out cause of death on death certificate?
Section 1 - immediate, direct cause of death - and causes - e.g. 1a - aspiration pneumonia, 1b - motor neurone disease
section 2 - other significant co-morbidities that contributed to death, but did not directly cause it e.g. atrial fibrillation
When should a death be referred to the coroner for post mortem?
No doctor attending within last 14 days Cause of death unknown Death occurred during operation/before recovery from anaesthetic Occurred at work/suspicion of occupational poisoning Sudden/unexpected suspicious circumstances Due to violence/neglect/suicide Occurred in prison/custody/detention
What information is required in what form on a death certificate?
GMC number
Age - in figures
Date of death - in words
Common doses available of co-codamol?
8/500 or 30/500
