Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Lau H(1), Law KY(2), Chan FS(2), Leung YC(2)
Affiliation :
(1) Department of Medicine and Geriatrics, Our Lady of Maryknoll Hospital
(2) Central Nursing Division, Our Lady of Maryknoll Hospital
Introduction :
The clinical care around death and dying is complex and likely to have room for improvement in general medical units, especially for non-cancer patients. Deficiencies include symptom management of patients, continuation of futile treatments or investigations, communication with families, and psychological and spiritual support for patients and families.
In order to enhance end-of-life care for non-cancer patients dying in the Department of Medicine & Geriatrics (M&G), Our Lady of Maryknoll Hospital(OLMH), the “Program on Care of Dying Patients in OLMH M&G Wards” is therefore proposed to provide a structured framework to guide quality care.
Objectives :
To provide holistic care for terminally ill M&G patients, who are in their dying phase, and the families / caregivers; with emphasis on patient centered care and dignity
To adopt a team approach on managing the needs of dying M&G patients and their families / caregivers
To provide a framework for evaluation of practice on care of dying M&G patients
Methodology :
Scope:
This program applies to terminally ill M&G patients who meet all of the following criteria:
Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) form for hospitalized patient is in place and valid
Diagnosis of terminal illnesses or irreversible cause(s) for clinical deterioration
Predict limited life expectancy within days
Patients will be excluded from this program if one of the following criteria is met:
Cardiopulmonary resuscitation or active disease management is preferred by family
Refusal from patient / family regarding the Program on Care of Dying Patients
Program Implementation:
A Care of Dying Workflow has been designed to provide guidance and assist clinical team in end of life care (EOL) decision making.
Four record forms have been created and adopted in the program to guide the clinical team for the appropriate EOL assessment, intervention and documentation.
1. Care Plan for the Dying (Part I, Doctor's Assessment and Prescription)
2. Care Plan for the Dying (Part II Nursing Assessment)
3. Care Plan for the Dying (Part II, Nursing Monitoring & Intervention Chart)
4. Care Plan for the Dying (Part II, Care after Death)
Training to staff:
The following training have been provided to the OLMH M&G ward staff before the start of the program
1. Overview of End-of-life Care
2. Care of Dying Patients
3. Breaking Bad News and Bereavement
4. Introduction of Program on Care of Dying Patients in OLMH M&G Wards
5. Organ Donation
Result & Outcome :
The following three outcomes have been chosen for program evaluation
1.Recruitment rate of eligible patients in the program
2.Staff satisfaction, morale and stress towards the program
3.Compliance audit on the care plan
There were two evaluations conducted on 3 months and 6 months after the start of the program:
Post 3 months evaluation
Patient recruitment rate: 47%
Staff satisfaction:
All staff showed appreciation on the program.
Compliance rate of Care Plan: >90%
Post 6 months evaluation
Recruitment rate: 60%
Compliance rate of Care Plan: >90%
Staff satisfaction:
All staff showed appreciation on the program and nurses can feel the gratitude from relatives although there is no formal evaluation on relatives’ perspective on the program.
