Palliative care, end of life decision + death certification Flashcards
(14 cards)
What are some signs that someone is end of life or in the dying phase?
- bed bound
- semi-comatose
- only able to take sips of fluid
- unable to take medicine orally
Symptoms of people in end of life
- pain
- N+V
- dyspnoea
- confusion + agitation
- constipation
- anorexia
- terminal secretions > death rattle due to fluid in back of throat
What is involved in the process of death certification?
- observe for signs of life for a minimum of 5 mins
- checking pupils (fixed + dilated)
- no pain response
- no palpable central pulse
- continuous asystole for at least 5 mins
- no breath or heart sounds after 2 minutes of auscultation
What happens when a patient dies in hospital?
- death certified by doctor
- transferred to the mortuary
- bereavement services arrange for a doctor who has cared for the patient over the last 14 days to complete the death certificate + cremation paperwork
How does the death certificate state the cause of death?
1a - cause of death
1b - condition leading to cause of death
1c - additional condition leading to 1b
2 - any contributing factors or conditions
When is old age acceptable as Ia cause of death of death certification?
patient was >80
Role of medical examiner
- independent review
- family engagement - explain cause + address concerns
- referral to coroner if needed
Process of death certification
- certifiying doctor completes the medical certificate of cause of death (MCCD)
- medical examiner (ME) reviews the MCCD, medical records + discusses the case with the certifying doctor
- ME amends the MCCD or confirms accuracy
- ME communicates with bereaved family for clarification + feedback
- ME decides whether the case should be referred to the coroner
In what situation should a death be reported to the coroner?
If the doctor knows or has reasonable cause to suspect that the death occurred due to:
- poisoning, use of controlled drug, medicinal product or toxic chemical
- trauma or violence
- a treatment or procedure of medical nature or within 30 days after
- self harm (incl. self neglect) or suicide
- injury or disease due to their work
- notifiable poisoning or diseases
- neglect or failure of care from another person e.g. severe malnutrition, bedsores
- sudden or unexpected death
- deaths in custody
- doctor attending deceased did not see them within 28 days before death
What is the coroner’s role?
to determine:
- who died
- where they died
- how they died
What does palliative care involve?
- symptoms + pain management
- emotional + psychological support
- coordination of care
- support for family
- assistance with practical needs
What is a RESPECT form?
Recommended Summary Plan for Emergency Care and Treatment
- a document that outlines a patient’s care preferences + clinical recommendations in the event of a medical emergency
- CPR yes/no
What is used if a patient lacks capacity, has no family to act in their best interest and has no advance care plan/RESPECT form etc?
Independent mental capacity adovcate
What is an independent mental capacity advocate?
An advocate appointed to act in the patient’s best interested if they lack capacity, have no family to do it form them and no documentation on their wishes
