PALLIATIVE CARE

As well as community palliative care, there is an inpatient Palliative Care team. This is a consulting service, usually for General Medicine admissions but certainly available to all specialties.

We frequently deal with patient’s who present to ED in pain and distress. When this pain and distress is the result of end-stage terminal illness, or incurable cancer at any stage, or if an elderly patient has suffered a critical and irreversible insult to their health - you will almost always find that a call to the Palliative Care team is helpful.

You will find the number for Palliative Care physician Dr. Gareth Watts on the on-call medical staff rostering document.

There is an advanced Trainee available in hours via switch

CARE FOR THE DYING PATIENT IN ED

It is not uncommon for patients to present with their families at the end of life, even when it is an expected death. In addition, people can have rapid and critical declines en-route to or in the ED. Sometimes the most appropriate and kindest thing we can do is to offer comfort care.

No one wants to see their patient or loved one suffer in their final moments. The provision of effective palliative care for a dying patient can have a profoundly positive effect on a patient’s family, and on those caring for the patient. In contrast, denial or inaction can escalate suffering for the patient, their family members, nursing and medical staff.

Once the decision has been made to shift the focus from curative treatment to dignified and comfortable dying there are several documents needed to optimise this process in ED:

  1. INITIATING LAST DAYS OF LIFE MANAGMENT PLAN

  2. cOMFORT OBSERVATION AND SYMPTOM ASSESSMENT CHART

  3. rESUSCITATION PLAN

  4. sUBCUTANEOUS INFUSION FORM (IF APPROPRIATE

  5. mEDCHART - PROTOCOL FOR PALLIATIVE CARE

For medical staff: Once the decision is made you will likely pick up a new patient and not return to review the dying patient or their family (except to confirm time of death). Therefore, if the RN caring for your patient has concerns about the patient’s pain, or agitation, or secretions, etc - take this concern seriously. If you don’t know how to manage the problem, talk to the FACEM or to the Palliative Care Physician on-call.