Authors (including presenting author) :
Lam PL, Mak YMK, Mak KS, Ho YL,Yeung W, Chan LW,Chan YH,Chu WT, Ng WC, Tsung WC
Affiliation :
Cheshire Home, Shatin
Introduction :
EOL care is gaining more attention in Hong Kong because it can benefit patients by improving their quality of life at the end stage of life. SCH is a 304-bed in-patient infirmary hospital and most of the patients are old age and frail. Thus, nursing team in SCH strived to provide better EOL care for the patients by reforming the nursing service.
Objectives :
1. To advocate EOL care and advance care planning (ACP) in SCH
2. To early initiate ACP and keep proper documentation of ACP discussion
3. To promote care-in-place by minimizing acute hospital transfer for frail patients with well-planned EOL care
4. To improve patient’s quality of life
Methodology :
Staff Training
Training for staff is fundamental to advocate the culture of EOL. Training was in the format of online courses, workshops and exposure program in EOL ward of Shatin Hospital. It emphasized on mind-set and skills to deliver EOL care. “Train-the-trainer” method was employed for nurses who joined the exposure program to share their experience. Also, an EOL care workgroup was established to promote ACP.
Initiation of ACP Discussion
Nurses acquired knowledge and technique of initiating ACP conversation and discussion. They selected suitable patients, provided information to patients and relatives, prepared them psychologically and started early ACP conversation. Finally, an ACP form was signed by patient/relative and doctor then kept in patient’s progress note with nurses to implement the care plan accordingly.
Avoid Unnecessary Transfer to Acute Hospital
In general, doctor reviewed patient’s condition monthly and nurses provided an updated clinical condition for doctors to early detect any abnormality and deterioration of patients.
Ward nurses contacted case doctors to review unstable cases before weekend and documented in case notes. Nursing supervisor had to ensure the case was reviewed by on-site doctor on Saturday to ensure continuity of care according to the plan .
Implementation of Treatment as Planned
When nurse made an urgent phone consultation to doctor during non-office hour or over weekend, content of ACP discussions such as “not for active resuscitation”, “not for acute hospital transfer” and “not for tube feeding” information would be clearly provided to on-call doctor for making appropriate clinical decision.
Leave with Peace and Dignity
Lastly, a warm and cozy home-feel comfort room with spiritual figures and pastel color bedding were designed to provide a peaceful atmosphere for imminently dying patients and their significant others.
Result & Outcome :
All nurses in SCH had completed 12-moduole Hospice Palliative Nursing Care online training. 74% of nursing and supporting have attended end-of-life care training organized by CUHK & HA. 6 nurses attended exposure program to Shatin Hospital EOL ward and held one sharing session.
For infirmary patients, ACP rate leaped form 1.4% in 2017 to 54% in August 2019. Unnecessary transfer and receiving acute invasive care was greatly minimized and there was 61% reduction in number of acute transfer per month. Moreover, there was a significant increase in the numbers and percentage of residents who opted for caring-in-place. With a similar death rate, 79% of passed-away patients died in SCH in 2018, which was significantly increased from 50% and 59% in 2016 and 2017 respectively.
