Authors (including presenting author) :
Chan SH, Yau WT, Leung MW
Affiliation :
Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong
Introduction :
Deaths occur in hospitals every day. Ensuring patients and families to experience a 'good death' is important. However, training and standardized protocols on developing high-quality end-of-life(EOL) care in acute ward setting are inadequate. Given this, EOL care program has been launched in acute ward since 2017. Case Medical Officer(MO) will recruit eligible patients to the program and use a care checklist which serves as a reminder for the clinical team to deliver comprehensive care for dying patients.
Objectives :
1. To encourage healthcare staff to use the 'Care Checklist for Imminently Dying Patient'. 2. To review the use of care checklist. 3. To identify the reasons why the care checklist was not used for imminently dying patients.
Methodology :
1.EOL care with the use of care checklist has been promoted to doctors and nurses in October, 2017. 2.All deaths from 1 November, 2017 to 30 November, 2017 were recorded in a standard record sheet. 3.Type of disease, Do-Not-Attempt Cardiopulmonary Resuscitation (DNACPR) order and medical condition prior death of recorded cases were reviewed. 4.The usage and completion of the care checklist were reviewed. 5.The reasons of not using the care checklist were analyzed.
Result & Outcome :
11 patients were recorded during the evaluation period. Four death was due to cancer. Other patients died from renal failure, respiratory failure, stroke, gastro-intestinal bleeding, pneumonia, post-cardiac arrest and myocardial infarction respectively. Only one patient died with comfort measures and used the care checklist. Three patients had sudden death with CPR. Four patients had anticipated deterioration with a DNACPR order and died with active life sustaining treatment such as use of inotropes, non-invasive or mechanical ventilation. Three patients had a DNACPR order and died with comfort measures. The reasons why the care checklist was not used for those three eligible patients were analyzed by interviewing the responsible nurses: 1. Case MO was not available, so the care checklist could not be initiated. 2. Case MO was not familiar with the checklist, so he rejected to use it. Better quality EOL care could be delivered to dying patients with use of the care checklist in acute medical ward setting. However, more promotion of EOL care program and the checklist to doctors is required.
