Going Well…… Care of the Dying in the Lyell ED

Dr Christine Drummond

Senior Palliative Care Consultant

Critical Care Services Project Officer

Lyell McEwin Hospital July 2014

Northern Adelaide Local Health Network

Rapid, effective and kind care – a medical emergency

Our ED: 5-10 deaths per month

> 2 groups of people

• Elderly people, multiple comorbidities, an acute

medical event, present in extremis, die within a few

hours. Transfer to a ward is too stressful for the

patient. Most common symptom is dyspnoea.

• Those who arrive post cardiac arrest in the

community, unsuccessful resus attempt

Themes from our staff survey: > We care, we want to be kind and do well, and

we feel stressed, upset and helpless when we

feel we cannot

> We acknowledge the environmental barriers in

caring for a dying person in a busy, noisy dept

> We recognise the stress and upset for loved

ones when someone dies in such a traumatic

circumstance

> We recognise that further education and a clear

process help in the care of patients and

ourselves

Dying in the ED Care Plan Facilitates

> Holistic clinical care

> Education

> Audit

> Staff resilience

> Community partnerships

Dying in the ED Care Plan > Is supported by Clinical Guidelines relevant to

the ED environment

> Is evidence-based and patient-centred

> Allows practitioners to exercise professional

judgement quickly, safely and in line with patient

need

> Facilitates communication

> Facilitates holistic, coordinated care

> Provides a clear documentation process,

including prompts

> Is part of the case notes

Dying in the ED Care Plan

> A clinical assessment, led by the Consultant, in

consultation with the patient and loved ones,

determines that the patient is dying and that the

focus of care is comfort

> The patient is then not for CPR, ICU, intubation or

MER calls

> Rapid, multi-D symptom assessment &

management occurs – no level of distress is

acceptable in the last hours of life

> Loved ones are educated about what they might

expect

Dying in the ED Care Plan

> Interventions, procedures &

medications that do not aid in providing

comfort are ceased, unless specific

reasons apply (and these are

documented)

> The best possible environment is

provided. Comfort cupboard resources

are utilised

> If any uncertainty about likely time to

death, process for ward transfer is

initiated, in case this is required

Extraordinary things can happen in ordinary places…

Comfort Cupboard

Dying in the ED Care Plan

> Care of loved ones:

• Inform Chaplains

• Provide physical comfort

• Ensure nominated contacts in case notes

are notified if no loved ones present

> Eye donation addressed

> GP notified of patient’s death

> Monthly audit of use and bereavement

service feedback

Partnerships > Lyell McEwin Regional Volunteer Association

> Northern Adelaide Medicare Local

> SA Palliative Care Council

Results so far……… > Well, I’m here, aren’t I……….

Results so far……… > A real sense of culture change and that we have done

something worthwhile – pride and staff resilience

> Increased staff knowledge of symptom management

strategies and spiritual care of the patient & loved

ones

> Audit within regular processes

> Increased comfort with chaplains being involved

> Our first eye donation!

> Bereavement referrals

> Excellent GP notification

> Significant use of Comfort Cupboard and staff

satisfaction with the environment

> Document modifications already planned

> ?cost savings

Thank you for your attention and the spirit in which you have participated…….Go well

Christine.Drummond@health.sa.gov.au