Palliative Care Services - Week 2 Flashcards
Why is palliative care imp
Good patient care - and feedback
Job satisfaction
Palliative med principles applied to all of Med
Exam questions
Global death rate stays constant at 100% - the ONION
What is palliative care ?
Is the active holistic care of patients with advanced , progressive illness
Management of pain and other symptoms and provision of psychological , social and spiritual support is paramount
Goal of palliative care is achievement of best quality of life for patients and their families
*Many aspects of palliative care are also applicable earlier in the course of the illness in conjunction with other treatments ‘
General palliative care
Core aspect of care of Pts with Advanced disease by all health professionals
Incl :
Holistic needs assessment and provision of basic symptom control
Referral to specialist palliative care or appropriate
All doctors need to provide palliative care as part of their management
CPR
CPR decision documented in 10% of admission notes
COR status was recorded in 22% during inpatient stay
52 Pts who received CPR were DNACPR
7 were on the LCP
44% post arrest - DNACPR
Initial assessment (up to first consultant review or first 24 hours if consultant review could not be identified ) was considered to be deficient in 48% or cases
40-50% or in hospital CPR is not appropriate
Own team should make decision not resus team - escalation to senior doctors
DNACPR
Only relates to CPR - all other treatment if appropriate will be given I.e antibiotics , drugs for symptom control ( analgesia) , oxygen
Identify dying
If reversible and appropriate - reverse
Key principles :
CPR is a medical treatment and cannot be demanded by Pts or their family
To offer futile treatments is ethically inappropriate
Although good practice , there is no obligation to explicitly discuss a DNACPR decision with dying Pts.
Specialist palliative care
Provided for - Pts and carers with unresolved symptoms and complex psychosocial issues with complex end of life and bereavement issues
Provided by : health professionals for whom palliative care is their core work who have undergone relevant training and increasingly provided by accredited specialists
Spectrum of skills and experience and training
MDT ( nurse , doctor , Physio , OT,SW, chaplain)
NICE - manual for improving supportive care and palliative care for adults with cancer
History
Hospices / safe places for dying but only offers simple medical and nursing care - many still in hospital when they die
Mid 20th century - med had developed specialisation , new treatments , incr emphasis on cure and rehab - dying in hospitals looked on as medical failure
1950s concern start regarding medical neglect of dying and vaccum of knowledge of end of life cafe
1950s
Systematic observation is US and UK
New view of dying to include finding out what Pts should and die know about their condition
Active rather Than passive approach to caring for dying encouraged , continuing to care up until the end of life and beyond to bereavement care for carers
Care extended to include not just imminently dying but also those with a terminal illness
Still a remainder of the death is failure and it continues to be a challenge to the medical world
Palliative care services
Generalist :
Primary health care team , nursing home , secondary care , social services
Specialist : clinical nurse specialists (community and hospital )
Specialist physicians in palliative care , hospices and Marie curie nurses
Complicated specialist service
NHS provided :
Community clinical nurse specialist , hospital clinical nurse specialist , some consultants , some In patient units , Macmillan - 3 yr pump prime
Voluntary sector :
Hospice services and most in patient beds (independent charity , Marie Curie , Sue Ryder and other)
Marie Curie nurses
Macmillan
What do specialists services provide ?
Hospice - IPU , day hospice , medical clinics , lymph oedema , complementary therapies , education , bereavement services ; out of hours advice , hospice at home , benefits advice
Hospital - medical / nursing staff advice and support to hospital staff
Community - Macmillan nurse , drop in centres
What do all the nurses do ?
District nurse - primary health care team , community based , generic palliative care skills , hands on nursing skills
Practice nurse - PHCT , practice based , generic palliative care skills , “hands on “
Marie Curie nurse - community based arranged by district nurse , specialist palliative care skills , “hands on”
Macmillan nurse - community or hospital based , specialist palliative care , advice , support and resource
Preferred place of care
Most people wish to die at home
Few people wish to die in hospital
Most die in hospital
Planning and co-ordination of care is required
How can you plan if you don’t know
Services involved
Hospice consultant
Community palliative care nurse specialist
Hospice out of hours advice phone line
GP
District nurse
Community occupational therapist
Out of hours primary care services
Challenges for future
With ever incr technologies and treatment options for the management of disease , how do we maintain a sense of humanity and compassion ?
It is vitally imp that the pt as a person isn’t lost and they we can remember that death is not necessarily a medical failure
