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