Going Well Best Care of the Dying in ED

Transcription

1 Going Well Best Care of the Dying in ED Spring Seminar Emergency Medicine, 30/9/2015 Rev Jeff May (LMH Coordinating Chaplain) Dr Chris Drummond (Clinical Lead, NAHLN EoL Initiative)

2 Why worry? Rapid, effective and kind care a medical emergency

3 A good death What does a good death look like to you? What are the elements of it?

4 A good death Good symptom management No prolongation of dying A sense of control No undue burden placed on their loved ones Strengthening of relationships. free from avoidable distress and suffering

5 Who dies in our ED? 2 distinct groups of patients: elderly patients with several medical comorbidities, who present in extremis due to an acute medical event and die within a few hours, often making transfer to any other setting stressful for the patient. younger patients who present after a cardiac arrest and are unable to be resuscitated.

6 Challenges to Care of the Dying in ED Can you identify the challenges in your ED?

7 Challenges to Care of the Dying in ED Attitude Environment Knowledge Skills Staffing No bereavement support It s not at all like home

8 Strengths of ED A tight team o Role clarity o Staff want to do this well Rapid response to medical emergencies o respond to only 1 chance to get this right o process-driven: ABCD Excellent volunteer support Clinical Champions and a Working Group

9 Key principles in Care Plan development People will always die in ED - care of the dying is core business Clinicians want to do no harm and do good, regardless of the clinical scenario we need knowledge and skills to achieve this Every effort is made to determine the patient s wishes and abide by them ED is part of the community what happens here has widespread, invisible ripple effects how we manage is important! o silo breakdown

10 Key principles continued. Holistic, patient-centred care incl bereavement o No level of distress is acceptable A death in ED is inherently traumatic Care of our community o family, friends, ourselves a healing experience education and support

11 Enablers to Care Plan development Comprehensive understanding of the local environment o patients, physical environment, staff Use a strengths-based approach Processes facilitate staff to exercise professional judgement quickly, safely and in line with patient need Community collaborations PCSA, NAML, Regional Volunteer Assoc, DonateLife

12 Enablers continued. A committed, educated team Consistency and reliability: o Evidence-based practice o Processes applicable 24/7 o Processes apply to all clinicians and are educative o Good communication embedded in the Care Plans o Good documentation, including prompts o Consistency in medication use Excellent clinical governance and supported by Clinical Guidelines

13 LEAN Principles Put the grunt up the front Don t fiddle in the middle Have a friend at the end

14 Nothing can go wrong if you don t have a plan Spike Milligan (In Hitler: my part in his downfall )

15 Dying in the ED Care Plan A clinical assessment, Consultant-led, in consultation with the patient and loved ones, determines that the patient is dying and that the focus of care is comfort Resuscitation Plan - 7 Step Pathway completed Rapid, multi-d symptom assessment & management occurs and continues consistency, pain asst hierarchy Loved ones are educated about what they might expect

16 Dying in the ED Care Plan Interventions, procedures & medications that do not aid in providing comfort are ceased, unless specific reasons apply The best possible environment is provided. Comfort cupboard resources are utilised If any uncertainty about likely time to death, process for ward transfer is initiated, in case this is required

17 Dying in the ED Care Plan Care of loved ones: o Inform Chaplains o Provide physical comfort o Ensure nominated contacts in case notes are notified if no loved ones present Eye donation addressed GP notified of patient s death Monthly audit of use and bereavement service feedback

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19 A PERSON WITH THEIR OWN LIFE STORY A PERSON IN RELATIONSHIP WITH OTHERS A PERSON WHO HAS LOST CONTROL OF THEIR LIFE AND IS NOW DEPENDENT A PERSON WITH QUESTIONS ABOUT SELF CONCEPT, WORTH, BEING AND MORTALITY A PERSON FOR WHOM YOU ARE NOW A VERY SIGNIFICANT OTHER A PERSON WHO MAY FIND MEANING IN A FAITH EXPRESSION A PERSON IN DISTRESS IN THEIR SPIRIT. WHO IS that in the BED? A PERSON WITH A MEDICAL ISSUE

20 Comfort Cupboard

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24 Extraordinary things can happen in ordinary places

25 Results so far A real sense of culture change and that we have done something worthwhile pride and staff resilience Increased staff knowledge of symptom Mx strategies and spiritual care of the patient & loved ones Audit within regular processes Increased comfort with chaplains being involved

26 Results so far Our first eye donation! Bereavement referrals Excellent GP notification Significant use of Comfort Cupboard and less staff concern with the environment Version 2 cost savings?? Principles have extended to where Care Plan not being used

27 Thank you for your attention and the spirit in which you have participated.go well