Planning for an Expected Death at Home An Initiative of The South East Palliative & End-of-Life Care Network Service Delivery Committee.
Palliative Care Care for those living with life-limiting, life-threatening illness Advance care planning is recommended as soon as you are able to introduce the topic to patient & family
Model for Palliative Care Frank Ferris Oct 2005 Therapies to modify disease End-of-life Care Hospice Palliative Care Presentation Therapies to relieve suffering and/or improve quality of life Death Bereavement Care
Planning for a Home Death Who pronounces death? Who is responsible for certification of death? Who does the family contact at time of death? What about the DNRC form? How do we help families prepare for death? Who makes sure everything gets done?
South East Local Health Integration Network Map
We Need a Plan! Working group established under the direction of the Palliative & End of Life Care Network Reported to the Service Delivery Committee of the Network Consultation with nurses, case managers, physicians, EMS, funeral directors
Do not resuscitate A plan of treatment is developed that reflects the expressed wish of the patient (or consent of the substitute decision maker for the person who is not capable) that CPR is not in the patient s plan of treatment. DNRC form is completed providing direction for EMS practitioners
The Yellow Folder
Yellow Folder Contents DNRC Form Yellow Magnet Algorithm Guidelines Brochure When Death Occurs at Home A checklist for Case Managers in folders at CCAC
What do you do with the magnet? The magnet is a signal that the yellow folder is in the home May be very helpful for EMS on a 911 call It is meant to be placed on the refrigerator door
The Algorithm A tool to assist with planning for pronouncement and certification of death Nurses (RN or RPN) can pronounce death Only a physician or RN(EC) can sign a death certificate
EXPECTED DEATH IN THE COMMUNITY PLANNING TOOL Patient s Name MD or RN (EC) or Medical Group Following discussion with family and physician indicate/circle plan. Will attend home to pronounce and certify 24/7 Will not attend home to pronounce or not available 24/7 Nurse pronounces MD or RN (EC) or Medical Group will not certify within 24 hours of death Funeral Home will accept nurse pronouncement and certification within 24 hours of death MD or RN (EC) or Medical Group will certify as soon as possible (within 24 hours of death) Funeral Home will not accept nurse pronouncement and certification within 24 hours of death Name Date Explore local options: Alternate MD or RN (EC) or Medical Group to certify within 24 hours of death Determine how to get death certificate to Funeral Home after completion Explore local options: Alternate MD or RN (EC) or Medical Group to attend home to pronounce and certify 24/7
Avoid calling the coroner unless there are reasons to contact them Avoid transfer of the body to ER for pronouncement and certification It is inappropriate to sign a death certificate prior to the death
Guidelines/Checklist Family/Caregiver/Agency at Time of Death Completed with family/informal caregiver Numbers to call at time of death: - professionals - family/friends Cultural considerations at time of death
Brochure: When Death Occurs at Home Guide for informal caregivers What to expect; what to do Information re: appetite, swallowing, sleep, confusion, breathing, bladder & bowel function, skin colour and temperature What will happen at the time of death
Who Introduces the Yellow Folder CCAC case manager Visiting nurse Consider PPS level & initiate discussion
Developed by Victoria Hospice Society
Who coordinates the process? The CCAC Case Manager will have a checklist of tasks to be completed. As each part of the process is completed, the Case Manager will record it on the checklist The Case Manager will address any gaps in the process Community Nurses to inform CM when yellow folder is in the home
Client Label PALLIATIVE CARE PLANNING CHECKLIST FOR EXPECTED HOME DEATH DATE (dd/mm/yy) TIME TASK YES NO N/A 1. Case Manager confirms which funeral home to use, and has permission to phone a)funeral Home Phone# b)funeral Director c)alternative Out of Area Arrangements 2. Funeral home is aware that care plan includes home death and has directions to the home 3. Funeral Home agrees to remove body without a completed death certificate* * If answer is No a physician or RN (EC) must agree to go to home to certify death. 4. Physician or RN (EC) agrees to go to home to certify death Physician or RN (EC) Pager # Phone # After Hours # Substitute Physician or RN (EC) Pager # Phone # After Hours # On Call Physician Phone # 5. If answer to #4 is No, physician or RN (EC) agrees that the nurse will pronounce death, allowing removal of body to funeral home. Physician or nurse practitioner agrees to provide death certificate to the funeral home within 24 hours (Record contact information in #4 above). 6. Physician or RN(EC) agrees that if all efforts to make contact fail at time of death, the process for the nurse to pronounce death will occur, as in #5 above. * Not applicable if answer to #3 is No. 7. Case Manager has confirmed the plan with the nursing service provider 8. Case manager has shared the plan with all other service providers 9. A) Brochure When Death Occurs at Home provided to family B) Family member/caregiver understands the procedure for home death 10. A) Client/family directives regarding resuscitation addressed B) Client s advance directives, if available, are documented and communicated 11. Confirmation that DNRC is completed and in the home 12. Copies of checklist to appropriate service providers Physician Funeral Home Service Providers CASE MANAGER PHONE # FAX # 1 of 1 Sept 2009
Facilitation of planning for expected death in the home will result in: DNR status identified appropriately Plans for pronouncement & certification in place Family is supported through the dying process Avoidance of unnecessary calls to EMS
Questions? Thanks!