11 - Advanced Care Planning Flashcards
(32 cards)
What situations is there likely to be a deprivation of liberty?
- The person is subject to continuous supervision and control and
- The person is not free to leave
what is the purpose of DolS
DoLS ensures people who cannot consent to their care arrangements in a care home or hospital are protected if those arrangements deprive them of their liberty.
they are subject to continuous supervision and control” and not free to leave
who is involved in setting up the DoLS
supervisory body. They can do this up to 28 days in advance of when they plan to deprive the person of their liberty.
What conditions need to be met in order for a DOLS to be put in place?
Remember some key facts for when someone is eligible for the dols
1. obvious -> the proposed restriction will restrict them of liberty
2. the restriction is in the persons best interest
what is an example of the dols
Ben has learning disabilities and Prader-Willi syndrome. There are concerns about his health because his weight has been increasing steadily and now stands at 120kg.
Staff in his residential home have tried to support Ben to limit what he eats and to make healthy choices but with little effect.
Ben has been assessed as lacking capacity to make decisions about the amount and type of food he eats (this is common among people with Prader-Willi syndrome). It has been proposed that it is in Ben’s best interests to stop him going into the kitchen, and always supervising him when out, to prevent him spending all his money on, or stealing, food. An application is made by the home manager for standard authorisation because they believe that the restrictions would deprive Ben of his liberty.
What are the five key principles of the Mental Capacity Act?
- Every adult is assumed to have capacity unless proved otherwise
- A person must be given all practicable help to make their own decisions before they are deemed to lack capacity
- Unwise, unsafe or dangerous decisions does not mean that person does not have capacity.
- All treatment given to a person who lacks capacity must be in the patients best interests
- Anything done for a person who lacks capacity must be done in the least restrictive way possible
What 4 things does somebody need to be able to do in order to have full capacity?
What is a Power of Attorney?
Legal document drawn up by a competent adult that nominates another person to make decisions on their behalf.
This can be related to financial and property, or health and welfare.
Can only be used when that adult has lost capacity.
What is an Advance Directive?
Medical decision made by a patient with capacity, regarding their future wishes for treatment. Only comes into force if a patient subsequently lacks capacity
THIS IS LEGALLY BINDING!!!!
What is the difference between an advanced statement and an advanced decision?
An Advance Decision only covers refusals of medical treatment
Advance Statement can include any information that you feel is important in relation to your health or care
What is an Advanced Decision?
Short for Advanced Decision to Refuse Treatment, is a legally binding document.
Ensures an individual can refuse a specific treatment(s) that they do not want to have in the future
What criteria needs to be met for an advanced decision to be legally binding?
What is an Advanced Statement?
“Statement of Wishes and Care Preferences”.
General statements about their wishes, beliefs, feelings and values and how these influence their preferences for their future care and treatment
Not legally binding, but legally must be taken into consideration when making a “best interests” decision on someone’s behalf under the Mental Capacity Act (MCA)
What are some things that may be included in an Advanced Statement?
Anything that is important to the individual e.g
- Religious or spiritual views
- Food preferences
- Information about your daily routine
- Where you would like to be cared for (in hospital, at home, in a care home etc.)
- Any people who you would like to be consulted when best interests decisions are being made on your behalf (however this does not give the same legal power as creating a Lasting Power of Attorney)
What is a ‘ceiling of care’?
Maximum level of care which the patient is set to receive
This is because their chances of survival may be very low and subjecting the patient to further painful, undignified interventions for minimal gain in their quality or quantity of life would be unethical
What things need to be considered in an EoL management plan?
- Review of poly pharmacy
- Take into account pt priorities
- Symptom control vs Curative treatment
What is medical futility?
The proposed therapy should not be performed because available data show that it will not improve the patient’s medical condition
Ethical issue in DNAR decisions as often patients family want them to live as long as possible but do not understand this may be causing more harm
Good communication between Doctor and Patients/Families can help overcome issues with this
What is age discrimination?
When a person is treated less favourably because
of their age
What strategies can be put into place to try and fight ageism in healthcare?
- Policy and Law
- Education Activities
- Intergenerational activities
What are some life-sustaining treatments that may be withdrawn when a patient is end of life?
- Feeding tube
- Dialysis
- Ventilators
What are some scenarios in end of life care that may need to have prescribed anticipatory drugs for symptom control?
- Pain
- Breathlessness
- Nausea and Vomiting
- Constipation
- Restlessness and Confusion
- Respiratory secretions
What are some anticipatory drugs prescribed for pain in the palliative process?
- Morphine: First line. Monitor for constipation and unwanted sedation
- Diamorphine
- Oxycodone
- Alfentanyl: for patients with renal failure who cannot take morphine
How do you calculate the dose of opioid to give for breakthrough analgesia in palliative care?
One sixth of the total daily dose
