Care Plan for End of Life

Size: px
Start display at page:

Download "Care Plan for End of Life"

Transcription

1 Insert organisational logo here Care Plan for End of Life Name NHS No Date of Birth Ward/Place of Care GP/Consultant Contact details District Nurse/ Clinical Nurse Specialist Contact Details Date of commencement: Time: Doctors name Signature Nurses name Signature Where to get further advice and support: In Hours Advice Out of Hours Advice Macmillan Specialist Palliative Care Team (Mon-Fri 9-5) Tel insert relevant number for organisation Macmillan Lung Cancer Team (Mon-Fri 9-5) Tel insert relevant number for organisation End of Life Care Team Partnership number East Cheshire Hospice Helpline (24 hour advice available) Tel St Luke s Hospice Helpline (24 hour advice available) Tel Others may be added specific to care setting Also refer to: NHS England- Principles of Care & Support for the Dying Patient The Cheshire EPAIGE : GMC Guidance for Care Towards the End of Life Draft 1.1 Review April 2014

2 Blank page to add references once content agreed 2

3 ALL STAFF Before commencing this care plan please refer to the CRITERIA below: Team agree deterioration in the person s condition suggests they have the potential to die in hours/days or they are imminently dying. 1. Exclude reversible cause s 2. Is specialist opinion needed from consultant with experience in person s condition &/or palliative care team? 3. Is there an Advance care plan or Advance Decision to Refuse Treatment? MULTIDISCIPLINARY TEAM ASSESSMENT AGREES Person is potentially imminently dying and no likely reversible causes identified All personnel completing the care plan please sign below: Name (print) Full signature Initials Professional title Date 3

4 DOCTORS & NURSES MEDICAL & NURSING TEAM REASSESSMENT & REVIEW Improved conscious level, functional ability, oral intake, mobility, ability to perform self- care and/o r Concern expressed regarding plan of care from the individual, relative/carer, or a team member and/o r It has been no more than 3 days since the last assessment discussion with the team caring for the Reassessment Discussion Dates: Date: Time: Name (print) Signature..Role Name (print). Signature..Role Date: Time: Name (print). Signature..Role Name (print). Signature..Role Date: Time: Name (print). Signature..Role Name (print). Signature..Role Date: Time: Name (print).. Signature..Role Name (print). Signature..Role. If this care plan is discontinued please record below: (this could be completed by a doctor or senior nurse following reassessment) Date: Time: Name (print)..signature..role Name (print). Signature..Role. Reason why this care plan has been discontinued: (please give details) Has the decision to discontinue this care plan been discussed with the patient? Yes No Has the decision to discontinue this care plan been discussed with the family/significant others? Yes No Name (print) Signature Role.. Date Names of family/significant others involved:..... Name (print) Signature. Role Date 4

5 DOCTORS & NURSES Section 1- Assessment & Communication Where the Doctor (ST3 or above) has identified that a patient under their care is dying or has the potential to die, they must discuss and agree a care plan with the patient (where possible) and with the patient s family/carer. Wherever possible this should be done in-hours and by the team that know the person best. The agreed plan of care should clarify the following: Recognition of dying or potential for dying and the rationale for this The person s understanding and wishes for treatment and care Proposed plan of care including discussion about; o Ceiling of care/cpr status o Risks and benefits of nutrition and hydration o Discontinuation of routine observations Names and roles of those involved in making the decision that this person could be in the last o Symptom control and medications prescribed for pain, nausea and vomiting, days/hours: dyspnoea, agitation and chest secretions including the need to commence a syringe pump if required Consider the needs of people with communication difficulties e.g. refer to patient passport Respond to the individual s, and/or their family/carer questions/concerns For those who lack capacity and have no-one else to support them (other than paid staff), please consider consulting an Independent Mental Capacity Advocate (IMCA). Date/Time Notes: Signature/Role 5

6 Date/Time Notes: Signature/Role 6

7 DOCTORS ONLY Section 2- Management Plan To be completed by a Doctor The decision to allow a natural death/do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) THIS has been made. Please record communication below, including the names of family members involved in the decision: (NB: a DNACPR form is still required) those who lack capacity and have no-one else to support them (other than paid staff),.date/time please consult with the IMCA service. of discussion.. This person is expected to die from natural causes and therefore would be a suitable patient for Nurse Verification of expected death, if a suitably qualified nurse trained in Nurse Verification of Expected Death is available Yes No Doctors Name (Print).Signature Date. Does this person have an Implantable Cardioverter Defibrillator (ICD) in situ? If yes, refer to local policy concerning deactivation. Alternatively, contact the patient s cardiology team Yes No Insert details of medical and nursing interventions to be discontinued: e.g. bloods, observations Date/Time Notes: Signature Insert details of medical and nursing interventions to be continued: e.g oxygen Date/Time Notes: Signature 7

8 DOCTORS ONLY PLEASE NOTE: Food and drink should be continued for as long as the dying person can tolerate this Are there any specific instructions concerning the maintenance of adequate hydration and nutrition for the person? e.g. continuation or discontinuation of artificial fluids. If there are, please detail below: Date/Time Notes: Signature Section 2 Continuation notes Date/Time Notes: Signature/Role 8

9 MULTIDISCIPLINARY TEAM Section 3- Preferences and Choices Where the person is able, they should be given the opportunity to discuss what is important to them. Examples of things the dying person may choose to discuss include: Where they would like to die (preferred place of death) Religious and/or spiritual requests capacity Consider and for the have person no-one who else lacks to capacity support or them is unconscious, (other than whether paid staff), they please have previously consult with the expressed IMCA service. a preference pertaining to their end of life care. This information may be contained within: An Advance Statement of Wishes/ Care Plan An Advanced Decision to Refuse Treatment (ADRT) Through a legally appointed Lasting Power of Attorney for Health & Welfare Patient Passport/ Person Centred Plan For all dying persons who are assessed to be lacking capacity and have no-one else to support them (other than paid staff), please consider consulting with the IMCA service What is the most important thing to this person at this time? (Continue overleaf if required) Date/Time Notes: Signature/Role Details of any Advance Statement of Wishes or expressed preferences e.g. Preferred Priorities for Care Date/Time Notes: Signature/Role Details of any ADRT or Lasting Power of Attorney for Health & Welfare: Date/Time Notes: Signature/Role 9

10 MULTIDISCIPLINARY TEAM Please Indicate Preferred Place of Death: Not established Usual Place of Residence Hospital Hospice Other (specify) Has the dying person and/or their family indicated any cultural/religious traditions that should be followed now or after death? Date/Time Notes Religious tradition (if applicable): Detail any expressed preferences concerning the support of the Chaplain or other religious or spiritual advisor: Where applicable, contact details of religious or spiritual advisor: Where applicable, identified cultural, spiritual, or religious needs immediate or after death: Signature/role Section 3- Continuation notes Date/Time Notes: Signature/Role 10

11 MULTIDISCIPLINARY TEAM Section 4- Family/Significant Others IDENTIFY THE SUPPORT NEEDS OF FAMILY/SIGNIFICANT OTHERS Ensure contact numbers updated for key family members Explain facilities available e.g. parking permits, folding beds for relatives Consider side room/ privacy of the environment Early referral to bereavement services if appropriate Address any concerns or information needs expressed by the family/significant others whilst observing patient confidentiality and consent What to expect during the last days and hours leaflet given to the family/significant others? Yes No offered but declined Are there any specific communication needs to consider for family members/significant others? E.g. interpreter required, deafness, anxiety. If yes please detail below Date/Time Notes: Signature/Role Next of Kin Details Name Relationship Contact details (address & tel) Conditions of contact Contact anytime do not contact during the night ONLY Contact 1 st contact detailed below Other instructions: 1 st Contact (if different from next of kin) 2 nd contact Name: Name: Address: Address: Tel: Contact: Anytime Not during the Night Tel: Contact: Anytime Not during the Night 11

12 MULTIDISCIPLINARY TEAM With whom have conversations taken place? Date/Time List all the names of family members/ significant others involved in conversations Signature/role Please use this space to record details of specific conversations held with family members /significant others. Date/Time Notes: Signature/Role 12

13 DOCTORS & NURSES Section 5- Symptom Control REVIEW CURRENT MEDICATION: Discuss and negotiate the management of symptoms Discontinuation of non-essential medications Anticipatory prescribing for the common symptoms that may occur at the end of life Consider the most appropriate route for medication to be given Optimise the control of symptoms, seeking Specialist Palliative Care advice where needed CONSIDER THE HOLISTIC MANAGEMENT OF SYMPTOMS i.e. psychological, spiritual, social, physical Consult with, and involve the wider multi-disciplinary team in the management of symptoms Seek Specialist Palliative Care Advice where appropriate Refer to local guidelines available via EPAIGE or on the intranet PLEASE ENSURE THAT ANTICIPATORY MEDICATIONS ARE PRESCRIBED FOR ALL 5 OF THE MOST COMMONLY EXPERIENCED SYMPTOMS: PAIN AGITATION RESPIRATORY TRACT SECRETIONS NAUSEA & VOMITING BREATHLESSNESS Please tick Not all patients will require a Syringe Driver However, staff should ensure that a syringe driver is readily available should this be required. Conversations with both the person and their family/significant others should also include information about when a syringe driver may or may not be indicated Details of conversations held with the person and their relative/ significant others concerning the management of symptoms at the end of life: Date/Time Notes: Signature/Role 13

14 Section 5 Continuation notes Date/Time Notes: Signature/Role 14

15 MULTIDISCIPLINARY TEAM Pain Section 6- Daily Assessment Day 1 Principles of Care & Support Observe for verbal and non-verbal signs of pain Person should appear comfortable on movement Reposition only for comfort measures DATE: DATE: DATE: DATE: DATE: TIME: TIME: TIME: TIME: TIME: Agitation Does not display signs of distress due to agitation Exclude reversible causes pain, urine retention, constipation, opioid toxicity, positional change If smoker consider need for nicotine patch Moist noisy breathing/respiratory tract secretions Consider need for positional change Explanation of symptoms to attending relatives If appropriate give medication for comfort (NOTE: medication will not clear existing secretions. If an individual is uncomfortable with a dry mouth it can dry this further) Nausea and/or vomiting Administer anti-emetic as indicated Consider other reversible causes for nausea/vomiting- smells, medication/chemical, Breathlessness Observe for verbal and non-verbal signs Consider comfort measures- positional change, use of fan, 02 Urinary and bowel function Consider urinary catheter for retention and/or comfort Provide pads if weakness causes incontinence Monitor & support skin integrity If distresses by constipation consider bowel intervention Safe administration of medication (mark N/A if no medication) If syringe driver is in place monitor during each review Medications administered in line with prescription and policy Clear written communication available to others that may need to administer medication Hydration Continue to support oral fluids if appropriate/tolerated Monitor for signs of distress or aspiration Continually review the appropriateness of any artificial fluids Mouth Care Assess and support mouth care during each review including support & advice to the family 15

16 MULTIDISCIPLINARY TEAM Skin integrity Where appropriate assess during each review Consider the use of aids Advise and support positioning based on comfort/safety needs only Personal hygiene Advice and support hygiene needs based upon comfort Environment of care Consider issues of privacy and dignity- side room, noise levels Other individual care need (give details below) Full signature & role of person completing assessment Compassionate and person centred communication with the dying individual (where possible) Consider issues of privacy and dignity- side room, noise levels Address any concerns, preferences, information needs Date/time notes Signature/Role Compassionate and person centred communication with the dying individual s family/significant others Address any concerns, preferences, information needs Ensure frequent updating concerning the condition of the dying person Date/time notes Signature/Role 16

17 MULTIDISCIPLINARY TEAM Pain Section 6- Daily Assessment Day 2 Principles of Care & Support Observe for verbal and non-verbal signs of pain Person should appear comfortable on movement Reposition only for comfort measures DATE: DATE: DATE: DATE: DATE: TIME: TIME: TIME: TIME: TIME: Agitation Does not display signs of distress due to agitation Exclude reversible causes pain, urine retention, constipation, opioid toxicity, positional change If smoker consider need for nicotine patch Moist noisy breathing/respiratory tract secretions Consider need for positional change Explanation of symptoms to attending relatives If appropriate give medication for comfort (NOTE: medication will not clear existing secretions. If an individual is uncomfortable with a dry mouth it can dry this further) Nausea and/or vomiting Administer anti-emetic as indicated Consider other reversible causes for nausea/vomiting- smells, medication/chemical, Breathlessness Observe for verbal and non-verbal signs Consider comfort measures- positional change, use of fan, 02 Urinary and bowel function Consider urinary catheter for retention and/or comfort Provide pads if weakness causes incontinence Monitor & support skin integrity If distresses by constipation consider bowel intervention Safe administration of medication (mark N/A if no medication) If syringe driver is in place monitor during each review Medications administered in line with prescription and policy Clear written communication available to others that may need to administer medication Hydration Continue to support oral fluids if appropriate/tolerated Monitor for signs of distress or aspiration Continually review the appropriateness of any artificial fluids Mouth Care Assess and support mouth care during each review including support & advice to the family 17

18 MULTIDISCIPLINARY TEAM Skin integrity Where appropriate assess during each review Consider the use of aids Advise and support positioning based on comfort/safety needs only Personal hygiene Advice and support hygiene needs based upon comfort Environment of care Consider issues of privacy and dignity- side room, noise levels Other individual care need (give details below) Full signature & role of person completing assessment Compassionate and person centred communication with the dying individual (where possible) Consider issues of privacy and dignity- side room, noise levels Address any concerns, preferences, information needs Date/time notes Signature/Role Compassionate and person centred communication with the dying individual s family/significant others Address any concerns, preferences, information needs Ensure frequent updating concerning the condition of the dying person Date/time notes Signature/Role 18

19 MULTIDISCIPLINARY TEAM Pain Section 6- Daily Assessment Day 3 Principles of Care & Support Observe for verbal and non-verbal signs of pain Person should appear comfortable on movement Reposition only for comfort measures DATE: DATE: DATE: DATE: DATE: TIME: TIME: TIME: TIME: TIME: Agitation Does not display signs of distress due to agitation Exclude reversible causes pain, urine retention, constipation, opioid toxicity, positional change If smoker consider need for nicotine patch Moist noisy breathing/respiratory tract secretions Consider need for positional change Explanation of symptoms to attending relatives If appropriate give medication for comfort (NOTE: medication will not clear existing secretions. If an individual is uncomfortable with a dry mouth it can dry this further) Nausea and/or vomiting Administer anti-emetic as indicated Consider other reversible causes for nausea/vomiting- smells, medication/chemical, Breathlessness Observe for verbal and non-verbal signs Consider comfort measures- positional change, use of fan, 02 Urinary and bowel function Consider urinary catheter for retention and/or comfort Provide pads if weakness causes incontinence Monitor & support skin integrity If distresses by constipation consider bowel intervention Safe administration of medication (mark N/A if no medication) If syringe driver is in place monitor during each review Medications administered in line with prescription and policy Clear written communication available to others that may need to administer medication Hydration Continue to support oral fluids if appropriate/tolerated Monitor for signs of distress or aspiration Continually review the appropriateness of any artificial fluids Mouth Care Assess and support mouth care during each review including support & advice to the family 19

20 MULTIDISCIPLINARY TEAM Skin integrity Where appropriate assess during each review Consider the use of aids Advise and support positioning based on comfort/safety needs only Personal hygiene Advice and support hygiene needs based upon comfort Environment of care Consider issues of privacy and dignity- side room, noise levels Other individual care need (give details below) Full signature & role of person completing assessment Compassionate and person centred communication with the dying individual (where possible) Consider issues of privacy and dignity- side room, noise levels Address any concerns, preferences, information needs Date/time notes Signature/Role Compassionate and person centred communication with the dying individual s family/significant others Address any concerns, preferences, information needs Ensure frequent updating concerning the condition of the dying person Date/time notes Signature/Role 20

21 Section 6 Continuation notes Date/Time Notes: Signature/Role 21

22 Section 6 Continuation notes Date/Time Notes: Signature/Role 22

23 Verification of death Section 7: After Death Care Date of death... Time of death... Persons present at time of death & relationship to the deceased Notes/Comments... If not present, has the patient s relative/carer been informed: Name of relative informed: Yes No No relative/carer Name of professional verifying death... Signature... Role... Time of verifying... Is discussion with, or review by, the coroner required Yes No If a Doctor has agreed to Nurse Verification of expected death (see page 7) and a trained nurse is verifying death, this section needs to be completed by the nurse (as per the NVoED policy). Vital signs checked: No response to painful stimuli (sternal rub) Yes No Carotid pulse absent for one minute Yes No Heart sounds absent for one minute Yes No Respirations absent for one minute Yes No Pupils fixed Yes No Care after death notes: record relevant issues/communications (including feedback from relatives) Date Name (print), signature & role 23

24 Organisation Information Relative /Carer/ Information Patient Care Dignity Communication & support after death Initial care after death is undertaken in accordance with policy Signature/date Consider: Patient is treated with respect & dignity if any care is provided after death Universal precautions & local policy & procedures including infection risk adhered to If CSCI/Syringe Driver in use, following verification of death, it is removed & drug contents disposed of in accordance with policy. Spiritual, religious, cultural rituals needs met The relative/carer understands what is required to do next & given relevant written information Consider relative/carer information needs relating to the next steps, where appropriate: Contacting a funeral director, how a death certificate will be issued, registering the death Acting on patient s wishes regarding tissue/organ donation Discuss as appropriate, the need for a post mortem, or removal of cardiac devices or when discussion with the coroner required Bereavement support/services, including child bereavement services Disposal of drugs & equipment Provision of supportive leaflet/booklets: Local bereavement booklet/services contacts/other bereavement information DWP1027 (England & Wales) What to do after a death booklet or equivalent The Primary Care Team/ GP Practice is notified of the patient s death Other services involved notified of patient s death Out of hour services (i.e. GPs, Nursing, other services) Yes No N/A Hospice Yes No N/A Macmillan Yes No N/A Other Specialist Nurse Yes No N/A Hospital Yes No N/A Out Patient Services e.g. Chemotherapy, endoscopy Yes No N/A Community Matron Yes No N/A Allied Health Professionals (i.e. Physio, OT, Dietician) Yes No N/A Social Services Yes No N/A Continuing Health Yes No N/A Other care agencies (i.e. Crossroads, Marie Curie) Yes No N/A Continence Yes No N/A Hospital Care at Home Yes No N/A Community equipment Yes No N/A Other, please state... Yes No N/A When this section is complete. Healthcare professional name (print)... Signature Role... Date... 24

25 Appendix 1: Symptom Control Guides GUIDELINES FOR CONTINUED USE OF TRANSDERMAL FENTANYL IN DYING PATIENTS When a person is no longer able to take oral breakthrough medication the fentanyl patch should continue to be changed every 72 hours as was prescribed unless there are toxic opioid side effects. A subcutaneous opioid should be given if the person experiences breakthrough pain. The breakthrough (4 hourly equivalent) dose of diamorphine, for example, is calculated by the following formula Fentanyl patch strength (mcg/hour) = 4 hourly dose of diamorphine 5 subcutaneously (mgs) *If subcutaneous morphine is used, the accepted conversion from subcutaneous morphine to subcutaneous diamorphine is 3:2 Table: Breakthrough doses of subcutaneous Diamorphine and Morphine for patients on Transdermal Fentanyl. Transdermal Fentanyl patch microgrammes per hour/72hours 4 hourly dose of Diamorphine subcutaneously (mgs) 4 hourly dose of Morphine subcutaneously (mgs) (*when diamorphine not available) consider as 2 separate injections as large volume will likely cause discomfort for patient If the person requires 2 or 3 doses of an opioid for breakthrough pain over a 24-hour period, consider commencing a continuous subcutaneous infusion of diamorphine/morphine in a syringe driver over 24 hours in addition to continuation of their fentanyl patch as prescribed. Example: Patient on 200mcg/hr fentanyl patch. The breakthrough (4 hourly equivalent) dose of subcutaneous diamorphine = 40mgs. Times that by 6 (lots of 4 hours) = the 24 hour equivalent. This is 240mgs. If x 3 breakthrough doses of diamorphine at 40mgs were required in the previous 24 hours. This equates to 120mgs total extra in 24 hours. Dose of diamorphine via syringe driver over 24 hours would be the additional 120 mgs. The 200mcg/hr fentanyl patch continues to be changed every 72 hours. NB: The breakthrough requirements need to be amended o Diamorphine equivalent of fentanyl patch = 240mgs o Plus diamorphine in syringe driver/24hours = 120mgs o Total diamorphine equivalent = 360mgs o 4 hourly equivalent diamorphine = 60mgs Needs to be reassessed at least every 24 hours. 25

26 For some people experiencing breakthrough pain, circumstances may prevent administration and titration of analgesic increase over that 24-hour period. It is reasonable to increase the total 24- hour analgesia by 1/3 Example: Person on 200mcg/hr fentanyl patch. The breakthrough (4 hourly equivalent) dose of subcutaneous diamorphine = 40mgs. Times that by 6 (lots of 4 hours) = the 24 hour equivalent. This is 240mgs. 1/3 of this = 80mgs. Dose of diamorphine via the syringe driver over 24 hours would be the additional 80mgs. The 200mcg/hr fentanyl patch continues to be changed every 72 hours. The breakthrough pain requirements need to be amended. i.e: o Diamorphine equivalent of fentanyl patch = 240mgs o Plus diamorphine in syringe driver/24hours = 80mgs o Total diamorphine equivalent = 320mgs o 4 hourly equivalent diamorphine = 53mgs o NB: round this up to the nearest 5 mgs for breakthrough (4 hrly equivalent) dose = 55mgs Needs to be reassessed at least every 24 hours. If a fentanyl patch needs to be discontinued, note that fentanyl plasma levels fall gradually due to continued absorption from the skin. Plasma fentanyl concentrations reduce by approximately 50% in 17 hours (range hours). If possible, it is advisable to use subcutaneous opioid stat injections for the initial 24 hours while the fentanyl plasma level is falling and start the syringe driver after 24 hours. Note: For further support or advice contact your Specialist Palliative Care Teams - see Reviewed 2011 by: Dr C G Smith, Medical Director, St Lukes (Cheshire) Hospice, Winsford Dr Trevor Rimmer, Macmillan Consultant in Palliative Medicine, Macclesfield DGH, 26

27 Insert organisational logo here BREATHLESSNESSES PRESENT ABSENT Is patient already on medium/strong oral opioid? Is patient already on medium/ strong oral opioid? YES Convert to CSCI*. Calculate equivalent dose of Diamorphine (see conversion chart in blue drug booklet) and increase by 30-50%. Also prescribe as required doses of Diamorphine (1/6th of total 24h dose), SC, 2 hrly. If distress of symptom persists, consider adding Midazolam by CSCI* 10-20mg/24h. Also prescribe as required doses of Midazolam NO Prescribe as required Diamorphine 2.5-5mg SC 2 hrly. And/Or as required Midazolam 2.5-5mg SC or buccal, 3 hrly. Review daily. If 2 or more as required doses given, consider CSCI* starting with either Diamorphine 10mg/24h Midazolam10mg/24h NO Prescribe as required Diamorphine 2.5-5mg SC,2 hrly. And/Or as required Midazolam 2.5-5mg SC or buccal, 3 hrly. If symptoms persist or further advice required contact the Specialist Palliative care team or local Hospice see front of Care Plan for contact details - if Diamorphine not available, use equivalent dose of Morphine Sulphate for injection. *CSCI continuous subcutaneous infusion via syringe driver Draft 1.1 Review April 2014

28 Insert organisational logo here MOIST NOISY BREATHING/RESPIRATORY TRACT SECRETIONS PRESENT ABSENT Prescribe stat dose of Glycopyronnium, 200 micrograms SC, repeated after 30mins if necessary Prescribe as required doses of Glycopyronnium 200 micrograms SC, 3 hrly (max 1200 micrograms/24h ) Or Prescribe stat dose of Hyoscine Butylbromide (buscopan) 20mgs, SC. Prescribe as required doses of Hyoscine Butylbromide 20mgs SC, 3 hrly (max 120mgs/24h ). Prescribe as required doses of Glycopyronnium 200 micrograms SC, 3 hrly (max 1200 micrograms/24h ) Or Prescribe as required doses of Hyoscine Butylbromide 20mgs SC, 3 hrly (max 120mgs/24h ). If 2 or more doses of as required are needed consider use of CSCI* Glycopyrronium 1200micrograms/24h by CSCI* Or Hyoscine Butylbromide mgs/24h by CSCI*Note: Drugs will not necessarily clear existing secretions. Treatment effective in 50-60% - more likely if noisy secretions due to unswallowed saliva, less likely if respiratory tract secretions. Many carers satisfied by explanation alone. A conscious patient treated with these drugs will be aware of an uncomfortably dry mouth If symptoms persist or further advice required contact the Specialist Palliative care team or local Hospice see front of Care Plan for contact details. Draft 1.1 Review April 2014

29 NAUSEA & VOMITING PRESENT ABSENT Give Cyclizine 50mgs SC as stat dose and start Cyclizine mgs/24h by CSCI* Or Give Haloperidol 1.5-5mgs as stat dose and start Haloperidol mgs/24h by CSCI* Prescribe Cyclizine 50mgs SC, 4-6 hrly (max200mgs/24h ) as required Or Haloperidol 1.5-5mgs SC, 4-6 hrly (max 15mgs/24h ) as required. Prescribe as required doses: Cyclizine 50mgs SC, 4-6 hrly (max 200mgs/24h ) Haloperidol 1.5-5mgs SC, 4-6 hrly (max 15mgs/24h ) If symptoms persist, see box below Review daily. If 2 or more as required doses given, consider converting to CSCI* If symptoms persist Cyclizine and Haloperidol can be used together by CSCI*. Or Convert to Levomepromazine, mgs/24h by CSCI* Prescribe as required Levomepromazine mgs SC, 3 hrly (max 75mgs/24h ) If symptoms persist, further advice required or patient has bowel obstruction, contact the Specialist Palliative care team or local Hospice see front of Care Plan for contact details. *CSCI continuous subcutaneous infusion via syringe driver. - maximums given as a guide. Seek Specialist palliative advice for further information if symptoms persist 29

30 PAIN PATIENT IS IN PAIN PATIENT S PAIN IS CONTROLLED Is patient already on medium/strong Is patient already on medium/ strong oral opioid? YES NO YES NO Convert to CSCI*. Calculate equivalent dose of Diamorphine (see conversion chart in blue drug booklet) and increase by 30-50%. Also give stat dose (1/6 th of total 24h dose). Also prescribe as required doses of Diamorphine (1/6th of total 24h dose), 2 hrly SC. Prescribe Diamorphine 2.5-5mg SC for as required 2 hrly and give 1st dose stat. Start CSCI* with Diamorphine 10mg/24h. Review daily. If required, increase 24h and as required dosages by 30-50% (more if as required doses given indicate). Convert to CSCI*. Calculate equivalent dose of Diamorphine (see conversion chart in blue drug booklet) Also prescribe as required doses of Diamorphine (1/6th ot total 24h dose), 2 hrly SC. Prescribe Diamorphine 2.5-5mg SC for as required 2 hrly. Review daily. If 2 or more as required doses given, consider CSCI* with Diamorphine 10mg/24h. NB:If on fentanyl patches, see NB:If on fentanyl patches, separate guidance sheet. see separate guidance sheet. If symptoms persist or further advice required contact the Specialist Palliative 30 care team or local Hospice see front of Care Plan for contact details. - if Diamorphine not available, use equivalent dose of Morphine Sulphate for injection (see blue drug booklet).

31 RESTLESSNESS & AGITATION PRESENT ABSENT Prescribe Midazolam 2.5-5mg SC stat dose, repeated after 30 mins if necessary And prescribe Midazolam 10-20mg/24h by CSCI* Prescribe as required doses of Midazolam mg SC, 3 hrly (max 60mg/24h ) Review daily. If 2 or more as required doses given, consider converting to CSCI* Prescribe as required doses of Midazolam If symptoms persist Prescribe Levomepromazine mg SC to give as a stat dose and for as required doses, 3 hrly.(max 150mg/24h ). If effective, consider adding Levomepromazine 25-50mg\24h to the Midazolam in the CSCI*. If symptoms persist or further advice required contact the Specialist Palliative care team or local Hospice see front of ICP or blue drug form for contact details. *CSCI continuous subcutaneous infusion via syringe driver. - maximums given as a guide. Seek Specialist palliative advice for further information if symptoms persist 31

32 Appendix 2-CPEOL Guideline (to be developed separately) To locally develop and to add more context and guidance for the specific sections of the care plan particularly for those less familiar with eolc. This can also include signposting to other guidance and resources that the National Leadership Alliance produces. Will also give us an opportunity to make anything that comes out from the leadership alliance explicit for example requirement for training. 32

Caring for the Dying Patient (CDP) Document

Caring for the Dying Patient (CDP) Document HCR320.1 April 2015 Page 1 of 18 The Care for the Dying Patient documentation has 5 core components: Page 1. Relatives / Carers Contact Information and healthcare professional s signatory information (C

More information

END OF LIFE MEDICINES INFORMATION PACK

END OF LIFE MEDICINES INFORMATION PACK END OF LIFE MEDICINES INFORMATION PACK Advice on end of life medication is available from the nursing and medical team at St Nicholas Hospice Care - telephone 01284 766133. Many drugs used in palliative

More information

URN: Part B - Comfort Care Chart To be completed by attending Nursing and Care Staff A new chart is to be commenced daily

URN: Part B - Comfort Care Chart To be completed by attending Nursing and Care Staff A new chart is to be commenced daily M F I The Brisbane South Palliative Care Collaborative (BSPCC) RAC EoLCP was developed as part of a project funded by the Department of Health and Ageing. The RAC EoLCP is adapted from the Liverpool Care

More information

Priorities of Care for the Dying Person Duties and Responsibilities of Health and Care Staff with prompts for practice

Priorities of Care for the Dying Person Duties and Responsibilities of Health and Care Staff with prompts for practice Priorities of Care for the Dying Person Duties and Responsibilities of Health and Care Staff with prompts for practice Published June 2014 by the Leadership Alliance for the Care of Dying People 1 About

More information

Palliative Care Integrated Clinical Pathway

Palliative Care Integrated Clinical Pathway Ward/Unit Date / / PALLIATIVE CARE INTEGRATED CLINICAL PATHWAY FOR E OF LIFE CARE The goal of care: Consideration for the whole person, Maximise quality of life through symptom management, Multidisciplinary

More information

P: Palliative Care. Alberta Licensed Practical Nurses Competency Profile 155

P: Palliative Care. Alberta Licensed Practical Nurses Competency Profile 155 P: Palliative Care Alberta Licensed Practical Nurses Competency Profile 155 Competency: P-1 Assess Physiological Change P-1-1 P-1-2 P-1-3 P-1-4 P-1-5 Demonstrate knowledge of the physiological characteristics

More information

GUIDELINES ON THE MANAGEMENT OF PAIN DUE TO CANCER IN ADULTS

GUIDELINES ON THE MANAGEMENT OF PAIN DUE TO CANCER IN ADULTS GUIDELINES ON THE MANAGEMENT OF PAIN DUE TO CANCER IN ADULTS Bristol Palliative Care Collaborative Contact Numbers: Hospital Specialist Palliative Care Teams: Frenchay 0117 340 6692 Southmead 0117 323

More information

Lymphoma and palliative care services

Lymphoma and palliative care services Produced 2010 Next revision due 2012 Lymphoma and palliative care services Introduction Despite improvements in treatment, many people with lymphoma will not be cured. Death and dying are things that people

More information

RGN JOY LAUDE WATFORD GENERAL HOSPITAL, ENGLAND

RGN JOY LAUDE WATFORD GENERAL HOSPITAL, ENGLAND RGN JOY LAUDE WATFORD GENERAL HOSPITAL, ENGLAND Monitor patient on the ward to detect trends in vital signs and to manage accordingly To recognise deteriorating trends and request relevant medical/out

More information

Community Pharmacists in NHS Rotherham

Community Pharmacists in NHS Rotherham SERVICE LEVEL AGREEMENT TO ENABLE COMMUNITY PHARMACISTS IN NHS ROTHERHAM TO PROVIDE PALLIATIVE CARE DRUGS AS LOCAL ENHANCED SERVICE PREPARED BY: NHS Rotherham CCG Medicines Management Team on behalf of

More information

The Pharmacological Management of Cancer Pain in Adults. Clinical Audit Tool

The Pharmacological Management of Cancer Pain in Adults. Clinical Audit Tool The Pharmacological Management of Cancer Pain in Adults Clinical Audit Tool 2015 This clinical audit tool accompanies the Pharmacological Management of Cancer Pain in Adults NCEC National Clinical Guideline

More information

Author s job title Interim End of Life Care Service Lead Directorate Medicine Directorate

Author s job title Interim End of Life Care Service Lead Directorate Medicine Directorate Document Control Title End of Life Care (Adults) Policy Author Interim End of Life Care Service Lead Author s job title Interim End of Life Care Service Lead Directorate Medicine Directorate Department

More information

Planning Ahead. A guide for patients and their carers

Planning Ahead. A guide for patients and their carers Planning Ahead A guide for patients and their carers Somerset Health Community January 2015 Planning ahead Content Page Introduction 3 Key references and useful websites 4 Section 1 Preferred priorities

More information

Planning for Your Future Care

Planning for Your Future Care Dorset Planning for Your Future Care Advance Care Planning Preparing for the future Assisting with practical arrangements Enabling the right care to be given at the right time This is a statement completed

More information

HOSPICE ORIENTATION FOR SKILLED NURSING FACILITIES

HOSPICE ORIENTATION FOR SKILLED NURSING FACILITIES HOSPICE ORIENTATION FOR SKILLED NURSING FACILITIES (2008 Medicare Conditions of Participation for Hospice Care 418.122 (f)) Hospice Philosophy Hospice is a unique concept of care designed to provide comfort

More information

Berkshire Healthcare NHS Foundation Trust Becky White CHS Pharmacist April 2013

Berkshire Healthcare NHS Foundation Trust Becky White CHS Pharmacist April 2013 Berkshire Healthcare NHS Foundation Trust Becky White CHS Pharmacist April 2013 Access to palliative care drugs out of hours Agreement set up with local community pharmacy s to hold stock of commonly prescribed

More information

WITHDRAWAL OF ANALGESIA AND SEDATION

WITHDRAWAL OF ANALGESIA AND SEDATION WITHDRAWAL OF ANALGESIA AND SEDATION Patients receiving analgesia and/or sedation for longer than 5-7 days may suffer withdrawal if these drugs are suddenly stopped. To prevent this happening drug doses

More information

Guide to the Pharmacological Management of End of Life (Terminal) Symptoms in Residential Aged Care Residents

Guide to the Pharmacological Management of End of Life (Terminal) Symptoms in Residential Aged Care Residents Guide to the Pharmacological Management of End of Life (Terminal) Symptoms in Residential Aged Care Residents Residential Aged Care Palliative Approach Toolkit Guide to the Pharmacological Management of

More information

Guideline for the use of subcutaneous hydration in palliative care (hypodermoclysis)

Guideline for the use of subcutaneous hydration in palliative care (hypodermoclysis) Guideline for the use of subcutaneous hydration in palliative care (hypodermoclysis) Date Approved by Network Governance September 2012 Date for Review September 2015 Page 1 of 7 1 Scope of Guideline 1.1

More information

Nursing Protocol for the Verification of Expected Death in the Community

Nursing Protocol for the Verification of Expected Death in the Community Nursing Protocol for the Verification of Expected Death in the Community 1.0 Introduction The intention of this policy is to support registered nurses in verifying expected death in the community for those

More information

PLANNING FUTURE CARE. Wishes & Preferences for My Future Care. This Plan belongs to:

PLANNING FUTURE CARE. Wishes & Preferences for My Future Care. This Plan belongs to: PLANNING FUTURE CARE Wishes & Preferences for My Future Care This Plan belongs to: Planning Your Future Care What is this Plan for? This Care Plan is your opportunity to think ahead and write down what

More information

A Guide to pain relief medicines For patients receiving Palliative Care

A Guide to pain relief medicines For patients receiving Palliative Care A Guide to pain relief medicines For patients receiving Palliative Care 1 Which pain medicines are you taking? Contents Page No. Amitriptyline 8 Codeine 9 Co-codamol 10 Co-dydramol 11 Diclofenac (Voltarol

More information

The Last Hours of Living

The Last Hours of Living The Last Hours of Living Ian Anderson Continuing Education Program in End-of of-life Care The Last Hours of Living! Over 90% of us will die after long illness! Last hours can be some of most significant

More information

What is hospice care? Answering questions about hospice care

What is hospice care? Answering questions about hospice care What is hospice care? Answering questions about hospice care Introduction If you, or someone close to you, have a life-limiting or terminal illness, you may have questions about the care you can get and

More information

Client Summary Palliative Care

Client Summary Palliative Care Client Summary Palliative Care DRAFT 2, March 2014 Gippsland Region Palliative Care Consortium Clinical Practice Group Policy No. Title Keywords Ratified GRPCC Client Summary Palliative Care After-hours,

More information

Guidelines for deactivating implantable cardioverter defibrillators (ICDs) in people nearing the end of their life

Guidelines for deactivating implantable cardioverter defibrillators (ICDs) in people nearing the end of their life Guidelines for deactivating implantable cardioverter defibrillators (ICDs) in people nearing the end of their life 1 March 2013 Guidelines for deactivating implantable cardioverter defibrillators (ICDs)

More information

Collaborative Care Plan for PAIN

Collaborative Care Plan for PAIN 1. Pain Assessment *Patient s own description of pain is the most reliable indicator for pain assessment. Pain intensity to be assessed using the ESAS (Edmonton Symptom Assessment Scale) Use 5 th Vital

More information

Draft. Principles and Guidance for the Last Days of Life: Te Ara Whakapiri - The Path of Closeness and Unity. April 2015

Draft. Principles and Guidance for the Last Days of Life: Te Ara Whakapiri - The Path of Closeness and Unity. April 2015 Draft Principles and Guidance for the Last Days of Life: Te Ara Whakapiri - The Path of Closeness and Unity April 2015 1 Palliative Care Council of New Zealand The Palliative Care Council ( PCC ) was established

More information

o Delivered by those with additional training and o Multi-disciplinary teams.

o Delivered by those with additional training and o Multi-disciplinary teams. BACUP/WATERFOOT DISTRICT NURSING TEAM TASK Devise a pathway for palliative care. PURPOSE To contribute to giving commissioners a clear view of the services we can provide and ultimately to enhance patient

More information

C1, C2 Continuing the Conversation: What is CRITICAL in providing comfort care?

C1, C2 Continuing the Conversation: What is CRITICAL in providing comfort care? C1, C2 Continuing the Conversation: What is CRITICAL in providing comfort care? Lorelei Sawchuk, RN, MN, CHPCN(C) Nurse Practitioner & Supervisor Palliative Care Program Royal Alexandra Hospital Edmonton,

More information

National end of life qualifications and Six Steps Programme. Core unit mapping tool for learning providers

National end of life qualifications and Six Steps Programme. Core unit mapping tool for learning providers National end of life qualifications and Six Steps Programme Core unit mapping tool for learning providers National end of life qualifications and Six Steps Programme - Core unit mapping tool for learning

More information

MONTANA Advance Directive Planning for Important Health Care Decisions

MONTANA Advance Directive Planning for Important Health Care Decisions MONTANA Advance Directive Planning for Important Health Care Decisions Caring Connections 1731 King St., Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 Caring Connections, a program of

More information

When Stopping Dialysis Treatment Is Your Choice. A Guide for Patients and Their Families

When Stopping Dialysis Treatment Is Your Choice. A Guide for Patients and Their Families When Stopping Dialysis Treatment Is Your Choice A Guide for Patients and Their Families National Kidney Foundation s Kidney Disease Outcomes Quality Initiative (NKF-KDOQI ) The National Kidney Foundation

More information

Recognition and management of the end of life in stroke patients. Dr Victor Pace Consultant, St Christopher s Hospice London April 2010

Recognition and management of the end of life in stroke patients. Dr Victor Pace Consultant, St Christopher s Hospice London April 2010 Recognition and management of the end of life in stroke patients Dr Victor Pace Consultant, St Christopher s Hospice London April 2010 What we shall cover overview of stroke and dying LCP: advantages and

More information

Examples of Good Practice Resource Guide

Examples of Good Practice Resource Guide Examples of Good Practice Resource Guide Just in Case Boxes August 2006 Gold Standards Framework Just in Case Boxes Resource Contents 1. Introduction 2. Gold Standards Framework guidance on developing

More information

How To Take A Strong Opioid Painkiller

How To Take A Strong Opioid Painkiller Using strong painkillers for cancer pain This information is an extract from the booklet Controlling cancer pain. You may find the full booklet helpful. We can send you a copy free see page 8. Contents

More information

Understanding late stage dementia Understanding dementia

Understanding late stage dementia Understanding dementia Understanding late stage dementia About this factsheet This factsheet is for relatives of people diagnosed with dementia. It provides information about what to expect as dementia progresses to late stage.

More information

Staff Resources Dying & Death in an Acute Hospital. End-of-Life Care Resources. Care After Death

Staff Resources Dying & Death in an Acute Hospital. End-of-Life Care Resources. Care After Death Staff Resources Dying & Death in an Acute Hospital End-of-Life Care Resources Care After Death The information below is from the Hospice Friendly Hospital Programme s Map for End-of-Life Care When a Patient

More information

What to expect when someone important to you is dying. A guide for carers, families and friends of dying people

What to expect when someone important to you is dying. A guide for carers, families and friends of dying people What to expect when someone important to you is dying A guide for carers, families and friends of dying people About this booklet If you are caring for someone who is in the last stages of life, or who

More information

Multidisciplinary Palliative Care Team Meeting

Multidisciplinary Palliative Care Team Meeting Multidisciplinary Palliative Care Team Meeting Mallee Division 2009-2010 DRAFT Operational Manual MDGP gratefully acknowledges the funding support from the Australian Government Department of Health and

More information

Strong opioids (painkillers) in palliative care what you should know

Strong opioids (painkillers) in palliative care what you should know Strong opioids (painkillers) in palliative care what you should know Patient Information Author ID: JG Leaflet Number: PC 006 Version: 1 Name of Leaflet: Strong opioids (painkillers) in palliative care

More information

Advance Health Care Directive. A guide for outlining your health care choices

Advance Health Care Directive. A guide for outlining your health care choices Advance Health Care Directive A guide for outlining your health care choices Table of Contents Making Your Wishes Known 2 Part 1: Choosing a Health Care Agent 4 My Health Care Agent 5 My Health Care Agent

More information

Macmillan Lung Cancer Clinical Nurse Specialist. Hospital Supportive & Specialist Palliative Care Team (HSSPCT)

Macmillan Lung Cancer Clinical Nurse Specialist. Hospital Supportive & Specialist Palliative Care Team (HSSPCT) Title Location Macmillan Lung Cancer Clinical Nurse Specialist Hospital Supportive & Specialist Palliative Care Team (HSSPCT) Grade 7 Reports to Responsible to HSSPCT Nursing Team Leader HSSPCT Nursing

More information

Service Specification for NHS Community Pharmacy Palliative Care Drugs Stockist Scheme

Service Specification for NHS Community Pharmacy Palliative Care Drugs Stockist Scheme Service Specification for NHS Community Pharmacy Palliative Care Drugs Stockist Scheme 1. This agreement is between NHS England North Midlands (Derbyshire/ Nottinghamshire only) (the Commissioner) Birch

More information

Planning for Your Future Care

Planning for Your Future Care Planning for Your Future Care Advance Care Planning Preparing for the future Assisting with practical arrangements Enabling the right care to be given at the right time Adapted from the Weston Hospicecare

More information

Development of Practical Skills. Practice Supervisor Report

Development of Practical Skills. Practice Supervisor Report Foundation Degree in Health Science Mental Health Care Development of Practical Skills Practice Supervisor Report Student Practice Supervisor.. SCHOOL OF HEALTH AND HUMAN SCIENCES UNIVERSITY OF ESSEX COLHESTER

More information

CH CONSCIOUS SEDATION

CH CONSCIOUS SEDATION Summary: CH CONSCIOUS SEDATION It is the policy of Carondelet Health that moderate conscious sedation of patients will be undertaken with appropriate evaluation and monitoring. Effective Date: 9/4/04 Revision

More information

Guidelines for the Use of Subcutaneous Medications in Palliative Care

Guidelines for the Use of Subcutaneous Medications in Palliative Care Guidelines for the Use of Subcutaneous Medications in Palliative Care Dec 2009 Review Dec 2011 1 Acknowledgments These guidelines have been adapted for local use with kind permission from NHS Greater Glasgow

More information

NHS Continuing Healthcare

NHS Continuing Healthcare NHS Continuing Healthcare Questionnaire In association with Questionnaire 1. Full name of patient 2. Home address (prior to transfer into care home if applicable) 3. Patient s Date of Birth 4. Patient

More information

Please Do Not Call 911

Please Do Not Call 911 The Last Hours of Life - What to Expect Names and Phone Numbers You May Need Name Phone Family Dr. Palliative Dr. After Hours Access Centre Visiting Nurse Hospice Clergy Funeral Contact Please Do Not Call

More information

My Future Care Plan. You can add to this as often as you like, and change your decisions at any time. This is YOUR plan.

My Future Care Plan. You can add to this as often as you like, and change your decisions at any time. This is YOUR plan. My Future Care Plan This plan is for you, to use to write down what you would like your friends, family/whanau, and health professionals caring for you to know. You can add to this as often as you like,

More information

SARASOTA MEMORIAL HOSPITAL STANDARDS OF CARE STANDARDS OF PRACTICE

SARASOTA MEMORIAL HOSPITAL STANDARDS OF CARE STANDARDS OF PRACTICE UNIT: INTENSIVE CARE UNIT - ICU SARASOTA MEMORIAL HOSPITAL STANDARDS OF CARE STANDARDS OF PRACTICE STANDARD #: EFFECTIVE DATE: REVISED DATE: STANDARD TYPE: INTENSIVE CARE UNIT-ICU STANDARD I - SAFETY 3/88

More information

O: Gerontology Nursing

O: Gerontology Nursing O: Gerontology Nursing Alberta Licensed Practical Nurses Competency Profile 145 Competency: O-1 Aging Process and Health Problems O-1-1 O-1-2 O-1-3 O-1-4 O-1-5 O-1-6 Demonstrate knowledge of effects of

More information

Document Ratification Group Approved on 25 th June 2009 Trust Executive Board Date July 2009 Next Review Date June 2011

Document Ratification Group Approved on 25 th June 2009 Trust Executive Board Date July 2009 Next Review Date June 2011 Verification of Adult Death by Registered Nurses Document Type: Policy Register Number: 07016 Status Public Developed in response to: Contributes to CQC Core Standard Hospital at night and Reduction in

More information

Central & Eastern Cheshire End of Life Care Competency Framework

Central & Eastern Cheshire End of Life Care Competency Framework Central & Eastern Cheshire End of Life Care Competency Framework Registered Nurses (St. Christopher s Level 2) Name:.. Formulated by Cheshire End of Life Care Model (2011), with acknowledgement to St.

More information

Partnering for Success. The Nursing Facility and Hospice Partnership to Provide End-of-Life Care To Nursing Facility Residents

Partnering for Success. The Nursing Facility and Hospice Partnership to Provide End-of-Life Care To Nursing Facility Residents Partnering for Success The Nursing Facility and Hospice Partnership to Provide End-of-Life Care To Nursing Facility Residents 1 What will I learn today? Attitudes towards death & dying Overview of hospice

More information

Using a Graseby MS26 Syringe Driver for Continuous Subcutaneous Infusions (CSCI) Protocol

Using a Graseby MS26 Syringe Driver for Continuous Subcutaneous Infusions (CSCI) Protocol Using a Graseby MS26 Syringe Driver for Continuous Subcutaneous Infusions (CSCI) Protocol Who Division 1 Registered Nursing staff for the purposes of administering and monitoring of infusion Division 2

More information

Leeds Teaching Hospital Ward Healthcheck Metrics Programme

Leeds Teaching Hospital Ward Healthcheck Metrics Programme Ward Healthcheck paper - Appendix 2 Appen Leeds Teaching Hospital Ward Healthcheck Metrics Programme Metrics Information Introduction The nursing care Metrics were initially developed in the north west

More information

Assessment & Rehabilitation Unit BALFOUR HOSPITAL STUDENTS HANDOUT

Assessment & Rehabilitation Unit BALFOUR HOSPITAL STUDENTS HANDOUT Assessment & Rehabilitation Unit BALFOUR HOSPITAL STUDENTS HANDOUT WHAT WE OFFER We believe that the older patient is an individual and therefore promote individualised care. This entails: Patient centred

More information

Opioids in Palliative Care- Patient Information Manual

Opioids in Palliative Care- Patient Information Manual Version 2.0 with MST example Introduction The following pages explain what opioids are and what we think you may want to know about them. There is quite a lot of information here, most of it is based on

More information

Nurse Initiated Medications Procedure

Nurse Initiated Medications Procedure 1. Purpose This Procedure is performed as a means of ensuring the safe administration of therapeutic medication to patients in accordance with all legislative and regulatory requirements. 2. Application

More information

IF YOU CHOOSE NOT TO START DIALYSIS TREATMENT

IF YOU CHOOSE NOT TO START DIALYSIS TREATMENT IF YOU CHOOSE NOT TO START DIALYSIS TREATMENT www.kidney.org For many people with kidney failure, dialysis helps them live longer and improves their quality of life. But for some people, the improvement

More information

ADVANCE DIRECTIVE. Your Right to Make Health Care Decisions

ADVANCE DIRECTIVE. Your Right to Make Health Care Decisions ADVANCE DIRECTIVE Your Right to Make Health Care Decisions 1 Saint Peter s University Hospital provides you with this booklet which explains your rights to decide about your health care under New Jersey

More information

Abstral Prescriber and Pharmacist Guide

Abstral Prescriber and Pharmacist Guide Abstral Prescriber and Pharmacist Guide fentanyl citrate sublingual tablets Introduction The Abstral Prescriber and Pharmacist Guide is designed to support healthcare professionals in the diagnosis of

More information

ADVANCE DIRECTIVE. A LIVING WILL A Directive To Withhold Or To Provide Treatment. A Durable Power Of Attorney FOR HEALTH CARE

ADVANCE DIRECTIVE. A LIVING WILL A Directive To Withhold Or To Provide Treatment. A Durable Power Of Attorney FOR HEALTH CARE ADVANCE DIRECTIVE A LIVING WILL A Directive To Withhold Or To Provide Treatment and A Durable Power Of Attorney FOR HEALTH CARE Name Date of Birth Form # 8-0553 (7-07) LIVING WILL AND DURABLE POWER OF

More information

MEDICINES MANAGEMENT STANDARD OPERATING PROCEDURE (MMSOP018) Preparation of Medication Administration Record (MAR) Charts

MEDICINES MANAGEMENT STANDARD OPERATING PROCEDURE (MMSOP018) Preparation of Medication Administration Record (MAR) Charts MEDICINES MANAGEMENT STANDARD OPERATING PROCEDURE (MMSOP018) Preparation of Medication Administration Record (MAR) Charts Any deviation in practice from this procedure must be discussed with the Community

More information

What is a Living Will?

What is a Living Will? What is a Living Will? With today s advances in medical technology, the process of dying can be prolonged by what are often referred to as artificial means. A Living Will can be used to let your healthcare

More information

Secondary liver cancer Patient Information Booklet

Secondary liver cancer Patient Information Booklet Secondary liver cancer Patient Information Booklet Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm

More information

Guidance for doctors. Treatment and care towards the end of life: good practice in decision making

Guidance for doctors. Treatment and care towards the end of life: good practice in decision making Guidance for doctors Treatment and care towards the end of life: good practice in decision making The duties of a doctor registered with the Patients must be able to trust doctors with their lives and

More information

Death Verification of Death and Medical Certificate of Cause of Death

Death Verification of Death and Medical Certificate of Cause of Death Policy Directive Ministry of Health, NSW 73 Miller Street North Sydney NSW 2060 Locked Mail Bag 961 North Sydney NSW 2059 Telephone (02) 9391 9000 Fax (02) 9391 9101 http://www.health.nsw.gov.au/policies/

More information

Procedure for the. Verification of Death by a Registered Nurse

Procedure for the. Verification of Death by a Registered Nurse Procedure for the Verification of Death by a Registered Nurse Version 1 Implementation date 1 st October 2009 Review date 1 st October 2011 Introduction This procedure has been developed to respond to

More information

The Code. Professional standards of practice and behaviour for nurses and midwives

The Code. Professional standards of practice and behaviour for nurses and midwives The Code Professional standards of practice and behaviour for nurses and midwives Introduction The Code contains the professional standards that registered nurses and midwives must uphold. UK nurses and

More information

p 6 Advance Healthcare Directive An easy-to-understand guide to help you make healthcare choices for the future

p 6 Advance Healthcare Directive An easy-to-understand guide to help you make healthcare choices for the future Advance Healthcare Directive An easy-to-understand guide to help you make healthcare choices for the future For more on why every adult needs an Advance Healthcare Directive, turn the page p To skip the

More information

Maryland MOLST. Guide for Authorized Decision Makers. Maryland MOLST Training Task Force

Maryland MOLST. Guide for Authorized Decision Makers. Maryland MOLST Training Task Force Maryland MOLST Guide for Authorized Decision Makers Maryland MOLST Training Task Force May 2012 Health Care Decision Making: Goals and Treatment Options Guide for Authorized Decision Makers Contents Introduction

More information

Opioid Agreement for Center for Pain Management S.C.

Opioid Agreement for Center for Pain Management S.C. Opioid Agreement for Center for Pain Management S.C. Patient Name: DOB: I am the patient named above. I have agreed to use pain medication as part of my treatment for chronic pain. I understand that these

More information

Palliative Care Pathway (12 hour shifts)

Palliative Care Pathway (12 hour shifts) STEP ONE Initiate Palliative Care Pathway (12 hour shifts) Resident/Patient Label The interdisciplinary team has agreed that the resident/patient is near end of life (last hours to days). Check those involved:

More information

Macmillan Oldham Community Specialist Palliative Care Team. An information guide

Macmillan Oldham Community Specialist Palliative Care Team. An information guide TO PROVIDE THE VERY BEST CARE FOR EACH PATIENT ON EVERY OCCASION Macmillan Oldham Community Specialist Palliative Care Team An information guide Macmillan Oldham Community Specialist Palliative Care Team

More information

Hospice Isle of Man. Education Prospectus 2016. Leading the Way in Palliative Care

Hospice Isle of Man. Education Prospectus 2016. Leading the Way in Palliative Care Hospice Isle of Man Education Prospectus 2016 Leading the Way in Palliative Care Introduction The need for palliative and end of life care is changing, with increasing demands and complexity. Therefore

More information

Implementing stock end-of-life medication in UK nursing homes. Kathy Morris, Jo Hockley

Implementing stock end-of-life medication in UK nursing homes. Kathy Morris, Jo Hockley Implementing stock end-of-life medication in UK nursing homes Kathy Morris, Jo Hockley Ab stract Background: In nursing care homes (NCHs), the use of end-of-life care (EoLC) medication has traditionally

More information

Anticipating And Preparing For Predictable Clinical Challenges In The Medical Care Of The Terminally Ill Person Wishing To Die At Home.

Anticipating And Preparing For Predictable Clinical Challenges In The Medical Care Of The Terminally Ill Person Wishing To Die At Home. Mike Harlos MD, CCFP, FCFP Professor, Faculty of Medicine, University of Manitoba Medical Director, WRHA Palliative Care Sub Program Medical Director, St. Boniface General Hospital Palliative Care Room

More information

Family Caregiver s Guide to Hospice and Palliative Care

Family Caregiver s Guide to Hospice and Palliative Care Family Caregiver Guide Family Caregiver s Guide to Hospice and Palliative Care Even though you have been through transitions before, this one may be harder. If you have been a family caregiver for a while,

More information

MODERATE SEDATION RECORD (formerly termed Conscious Sedation)

MODERATE SEDATION RECORD (formerly termed Conscious Sedation) (POLICY #DOC-051) Page 1 of 6 WELLSPAN HEALTH - YORK HOSPITAL NURSING POLICY AND PROCEDURE Dates: Original Issue: September 1998 Annual Review: March 2012 Revised: March 2010 Submitted by: Brenda Artz

More information

Nurses Self Paced Learning Module on Pain Management

Nurses Self Paced Learning Module on Pain Management Nurses Self Paced Learning Module on Pain Management Dominican Santa Cruz Hospital Santa Cruz, California Developed by: Strategic Planning Committee Dominican Santa Cruz Hospital 1555 Soquel Drive Santa

More information

Communicating Effectively with Healthcare Providers

Communicating Effectively with Healthcare Providers Communicating Effectively with Healthcare Providers Presented by: APS Healthcare Southwestern PA Health Care Quality Unit (APS HCQU) August 2011 cap Disclaimer Information or education provided by the

More information

Information for Patients. Advance Health Care Directive Kit A guide to help you express your health care wishes

Information for Patients. Advance Health Care Directive Kit A guide to help you express your health care wishes Information for Patients Advance Health Care Directive Kit A guide to help you express your health care wishes Table of contents PART I - REQUIRED Selection of a decision maker Who will make health care

More information

The End of Life Care Strategy promoting high quality care for all adults at the end of life. Prof Mike Richards July 2008

The End of Life Care Strategy promoting high quality care for all adults at the end of life. Prof Mike Richards July 2008 The End of Life Care Strategy promoting high quality care for all adults at the end of life Prof Mike Richards July 2008 The End of Life Care Strategy: Rationale (1) Around 500,000 people die in England

More information

Adjunctive psychosocial intervention. Conditions requiring dose reduction. Immediate, peak plasma concentration is reached within 1 hour.

Adjunctive psychosocial intervention. Conditions requiring dose reduction. Immediate, peak plasma concentration is reached within 1 hour. Shared Care Guideline for Prescription and monitoring of Naltrexone Hydrochloride in alcohol dependence Author(s)/Originator(s): (please state author name and department) Dr Daly - Consultant Psychiatrist,

More information

Leeds Palliative Care Ambulance Transport Working Group Date - Version 10.2 Update

Leeds Palliative Care Ambulance Transport Working Group Date - Version 10.2 Update Yorkshire Ambulance Service NHS Trust LEEDS PALLIATIVE CARE AMBULANCE OPERATIONAL POLICY Author: Leeds Palliative Care Transport Working Group Date: November 2013 Version: Version 10 1 Introduction 1.1

More information

Power of Attorney for Health Care For

Power of Attorney for Health Care For Power of Attorney for Health Care For Name: Date of Birth: Address: Telephone: This document is on file at Copies of this document have been given to my health care agent(s) and: 1. 2. 3. 4. 5. Courtesy

More information

On Demand Availability of Palliative Care Drugs Service

On Demand Availability of Palliative Care Drugs Service On Demand Availability of Palliative Care Drugs Service Locally Enhanced Service Author: Peer Review: Produced For review April 2013 Ruth Buchan, Senior Pharmacist Julie Landale, HoMM NHS Calderdale 4th

More information

CUESTA COLLEGE REGISTERED NURSING PROGRAM CRITICAL ELEMENTS

CUESTA COLLEGE REGISTERED NURSING PROGRAM CRITICAL ELEMENTS CUESTA COLLEGE REGISTERED NURSING PROGRAM CRITICAL ELEMENTS LEVELS I through IV A. OVERRIDING CRITICAL ELEMENTS Violation of an overriding area will result in termination and failure of the particular

More information

Georgia Advance Directive for Health Care

Georgia Advance Directive for Health Care Georgia Advance Directive for Health Care In order to have a legal document that expresses your wishes for the health care you want to receive at the end of your life, you should complete a Georgia Advance

More information

NATIONAL RAPID DISCHARGE GUIDANCE FOR PATIENTS WHO WISH TO DIE AT HOME

NATIONAL RAPID DISCHARGE GUIDANCE FOR PATIENTS WHO WISH TO DIE AT HOME NATIONAL RAPID DISCHARGE GUIDANCE FOR PATIENTS WHO WISH TO DIE AT HOME National Clinical Programme for Palliative Care Clinical Strategy and Programmes Directorate Health Service Executive Date of Publication:

More information

Epidurals for pain relief after surgery

Epidurals for pain relief after surgery Epidurals for pain relief after surgery This information leaflet is for anyone who may benefit from an epidural for pain relief after surgery. We hope it will help you to ask questions and direct you to

More information

University College Hospital. Your child is having an MRI scan under sedation. Imaging Department

University College Hospital. Your child is having an MRI scan under sedation. Imaging Department University College Hospital Your child is having an MRI scan under sedation Imaging Department If you would like this document in another language or format, or require the services of an interpreter,

More information

Recovery After Stroke: Bladder & Bowel Function

Recovery After Stroke: Bladder & Bowel Function Recovery After Stroke: Bladder & Bowel Function Problems with bladder and bowel function are common but distressing for stroke survivors. Going to the bathroom after suffering a stroke may be complicated

More information

National Hospital for Neurology and Neurosurgery. Managing Spasticity. Spasticity Service

National Hospital for Neurology and Neurosurgery. Managing Spasticity. Spasticity Service National Hospital for Neurology and Neurosurgery Managing Spasticity Spasticity Service If you would like this document in another language or format, or require the services of an interpreter please contact

More information

Document Details Title. Early Warning Score Protocol for Community Hospitals and Prisons to detect the Deteriorating Patient

Document Details Title. Early Warning Score Protocol for Community Hospitals and Prisons to detect the Deteriorating Patient Document Details Title Early warning Score Protocol for community Hospitals and Prisons to Detect the Deteriorating Patient Trust Ref No 1558-29748 Local Ref (optional) Main points the document This protocol

More information

Survey to Doctors in England End of Life Care Report prepared for The National Audit Office

Survey to Doctors in England End of Life Care Report prepared for The National Audit Office Survey to Doctors in England End of Life Care Report prepared for The National Audit Office 1 2008, medeconnect Table of Contents 1 SUMMARY OF FINDINGS... 3 2 INTRODUCTION... 5 3 RESEARCH OBJECTIVES AND

More information

Local Enhanced Service Specification for the Supply of Pharmaceutical Services to Care Homes through Community Pharmacy

Local Enhanced Service Specification for the Supply of Pharmaceutical Services to Care Homes through Community Pharmacy Local Enhanced Service Specification for the Supply of Pharmaceutical Services to Care Homes through Community Pharmacy Contents: 1. Introduction and purpose 2. Period of Service 3. Aim of the Service

More information