End of life care in Secure Psychiatric Settings
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1 End of life care in Secure Psychiatric Dr Nuwan Galappathie MBChB MRCPsych MMedSc LLM Consultant Forensic Psychiatrist St Andrew s Healthcare, Birmingham Visiting Researcher, Institute of Psychiatry, Kings College, London
2 CONTENTS Introduction Physical healthcare provision End of life care within secure settings Conclusion
3 Introduction Terminal Illness Cancer Cardiovascular disease Dementia Secure Care Restrictive settings Ability to use leave Capacity issues
4 Terminal Illness 500,000 UK deaths per year 50% of people die in hospital Increasing number of long term patients within secure care Increasing need for good end of life care
5
6
7 The History and Need for Change End of Life Care Strategy Department of Health, 2008 General Medical Council s (GMC) guidance document on Good Practice in Decision Making. End of life pathways Gold Standards Framework. Liverpool Care Pathway.
8 In June 2014, The Leadership Alliance for the Care of Dying People (LACDP), One Chance to Get it Right.
9 Priorities for Care of the Dying Person 1. This possibility is recognised and communicated clearly, decisions made and actions taken in accordance with the person s needs and wishes, and these are regularly reviewed and decisions revised accordingly. 2. Sensitive communication takes place between staff and the dying person, and those identified as important to them.
10 3. The dying person, and those identified as important to them, are involved in decisions about treatment and care to the extent that the dying person wants. social and spiritual support, is agreed, coordinated and delivered with compassion. 4. The needs of families and others identified as important to the dying person are actively explored, respected and met as far as possible. 5. An individual plan of care, which includes food and drink, symptom control and psychological,
11 Diagnosis of terminal illness Investigations Specialist referral Curative / Palliative Communication of diagnosis / involvement of family / chaplaincy at early stage
12 Setting Secure hospital vs transfer to hospice/ care home Patient / family wishes
13 Support Physical healthcare team MDT GP Palliative care team / nurse/ consultant Accessing district nursing Chaplaincy
14 PHYSICAL HEALTH Symptoms Pain Breathlessness Nausea/ Vomiting Weakness DNR CPR GP/ Family / Patient
15 Medication Review / stop non essential medications Oral/ subcutaneous Anticipatory prescribing Consider issues relevant to secure care setting e.g IV syringe drivers may not be appropriate Analgesia: liaise with GP / Palliative Care Team Consider oromorph / fentanyl patch
16
17 SOCIAL Family Will solicitor / testamentary capacity Funeral arrangements
18 PSYCHOLOGICAL Support for patient, staff and family Palliative care team Effects on the inpatient team in caring for a long term patient during their end of life care
19 SPIRITUAL Chaplaincy support Spiritual needs Funeral service
20 Conclusion Long term patients in secure care Need for good end of life care in secure settings in order to meet: Medical Psychological Social Spiritual needs
21 References and Resources End-of-life care in psychiatry: one chance to get it right Nuwan Galappathie, Sobia Tamim Khan, BJPsych Bulletin, Feb 2016; 40(1):38-40
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