Download Care for the Dying: A Pathway to Excellence by John Ellershaw, Susie Wilkinson PDF

By John Ellershaw, Susie Wilkinson

Marie Curie Centre Liverpool, united kingdom. textual content presents instructions for the care of the loss of life in keeping with the Liverpool built-in Care Pathway for the death sufferer (LCP). comprises evidence-based practices and describes the method of care and results. Discusses bedside documentation structures, rules and strategies, criteria of perform, and caliber development courses. Softcover.

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As the patient becomes progressively weaker, oral administration of medication may no longer be possible and drugs are commonly given via the subcutaneous route. The rectal route can be used, although suitable preparations do not exist for all drugs. Oxygen may be used for hypoxic patients, although the evidence is weak (22). If the patient is unconscious, consideration to discontinue this treatment can be made. Patients with dyspnoea typically experience tachypnoea and anxiety. It is believed that by reducing the respiratory rate and addressing the associated anxiety, the perception of breathlessness is also reduced.

Benzodiazepines like midazolam occasionally cause paradoxical behaviour reactions. Haloperidol is usually preferred to phenothiazines by psychiatrists because of its superior side-effect profile (13), but levomepromazine or chlorpromazine have both found to be safe and effective in the dying phase in palliative care (15, 16). 5–3 mg) or subcutaneous (1–2 mg) boluses every 30 minutes to one hour, until the patient settles. The total amount given can then be administered over 24 hours either in divided doses or in a syringe driver.

An example is given in Appendix 5. Goal 9 states ‘GP practice is aware of patient’s condition’. If the GP admitted the patient to the hospital or hospice because they were dying then the goal can be recorded as a YES. There is some debate whether the GP otherwise needs to be informed if the patient is dying. It is however a time when family members may attend the GP surgery for additional support and therefore it is important that the GP is aware that the patient is dying. It is also important to improve communication between primary and secondary care although it is sometimes difficult to contact the GP practice at night and weekends this should be recorded as a variance.

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