Palliative care and Death Certification Flashcards
(30 cards)
What should be done, where possible, with regards to end of life care?
- Advanced decision making re wishes of care inc resucitation and treatment options
- Discuss this with pt and family
When is palliative care important?
- When curative care is not possible and care needs to switch to more hollistic approach
What tool was previously used in terms of end of life care which has now been scrutinised?
- Liverpool care pathway - care should now be individualised for each patient and concentrate and focus on theri needs
- Individualised care plans should be completed
Eating and drinking at EOL
- Still able to enjoy food and drink if they are conscious and safe to swallow
Priority for EOL
- Dignity
- Comfort
What are advanced directives?
- State how patients wish to managed at end of life if they are unable to communicate it themsleves
- These must be seen and reviewed
- Patients are able to refuse treatment but not request
When can end of life/dying phase be recognised - at what stage of disease?
- Bed bound
- Semi-comatose
- Only able to take sips of fluid
- Unable to take medicine orally
Symptoms of people facing EOL
- Pain
- N+V
- Dyspnoea
- Agitation
- Confusion
- Constipation
- Anorexia
- Terminal secretions
What type of care should continue and be stopped at EOL?
- Personal care continue
- Observations if no longer appropriate - stop
- Regular mouth care prescribed and given
What staff can support at EOL care?
- Macmillan nurses
- Palliative care team
- Hospices and community hospital beds are available for pts with ongoing treatment or support - majority can be cared for at home
Who does death certification?
- Medical doctor
What is involved in certification process?
- Checking pupils are fixed and dilated
- No response to pain
- No breath or heart sounds after 1 minute of auscultation
What happens after death is certified?
- Patient transferred to mortuary and bereavement services
- A doctor who has cared for the patient within the last 14 days completes the death certificate and cremation paperwork
How does the death certificate state cause of death?
1a - Cause of death
1b - Condition leading to cause of death
1c - Additional condition leading to 1b
2 - any contributing factors/conditions
Example of death certificate cause of death layout
1a - Type 2 respiratory failure
1b - Congestive cardiac failure
1c - Myocardial infarction
2 - ischaemic heart disease, Hypertension, Diabetes mellitus
How is cremation paperwork completed?
- 2 independent doctors
- One must have cared for the patient
- Part 1 is completed by doctor who knows pt
- Part 2 is completed by independent doctor, 2 years post registration seeking confirmation of cause of death from variety of sources
What must be removed before cremation?
- Body pacemakers
- Radioactive implants
What to be aware of re beliefs post death?
Some religions require burial within 24hrs
When should death be reported to coroner?
When a doctor knows or has reasonable cause to suspect the death:
* Occurred as a result of poisoning, use of controlled drug, medicinal product or toxic chemical
* Occured as a result of trauma, violence or phsyical injury, whether inflicted intentionally or otherwise
* is related to any treatment or procedure of a medical or simular nature
* occurred as a result of self harm (inc failure to preserve their own life) whether intentional or otherwise
* injury or disease received during or attributed to course of persons work
* occured as result of a notifiable accident, poisoning or disease
* result of neglect or failure by another person
* was otherwise unnatural
When else should coroner be informed?
- Death occurred in custody of state detention (inc DoLS)
- No attending practitioner attended the deceased at any time in the 14 days prior to death or no attending practitioner is available withina reasonale period to prepare an MCCD
- Identity of deceased is unknown
What is the role of coroner?
- Determine who died
- Where they died
- How they died
- They do not comment on care but have powers to insist on further local investigation
- Can decide to hold an inquest to ascertain answers to the questions above
When is Amber care used in hospital?
If think have maybe weeks/months to live
Unsure if will survive this admission
Dr role in palliative care
- Identify those who need it
- Evaluate pt
- Anticipate problems and minimise progressive problems
- Manage distressing symptoms
- Educate family and pt on prognosis
- Clarify treatment goals
3 triggers to think about that can suggest rapid decline in organ function and potential need for palliation
- Suprise - would I be suprised if patient died in a few months, weeks, days
- Decline - deterioration, increased requirements for treatment eg O2
- Specific clinical indications depending on condition
