Authors (including presenting author) :
Sarah SW Chu (1) Wong OF (1) Irene YC Shiu (1) Tang KT (1) Cheng SK(1) Ma H M (1) Albert Lit (1) (1) Accident and Emergency Department, North Lantau Hospital.
Affiliation :
(1) Accident and Emergency Department, North Lantau Hospital.
Introduction :
End-of-life (EOL) service is introduced in Emergency Medicine Ward (EMW) to relief of symptoms including pain that interferes with the quality of life. It has been established in the Accident and Emergency (A&E) Department of North Lantau Hospital (NLTH since July, 2017. Till end of 2018, over 40 patients were managed under this End-of-life program. The program is a protocol-driven service targeting patient with terminal malignancy with documented advanced directives or post cardiac arrest patients with profound hypoxic brain injury. Patients with advanced, progressive and irreversible diseases who fail to respond to therapy and have a short life expectancy in terms of days while also be recruited and introduced to this EOL care.
Objectives :
(1) To affirm the practice of withholding and withdrawing life-sustaining treatment as an acceptable practice in clinically appropriate situations (2) To standardize the procedure and practice in withholding and withdrawing life-sustaining treatment in NLTH EMW/ AED (3) To delineate the ethical principles and the communication pathways in making decision on withholding and withdrawing life-sustaining treatment (4) To ensure terminally ill patients receiving proper end-of-life care
Methodology :
Implementation: (1) EOL care should be activated by the “Withholding or withdrawing life-sustaining therapy and end-of-life care checklist”. (2) Adequate information should be provided to patients and their families in order to make informed decisions regarding care and treatment. (3) Their unique needs, values and wishes should be acknowledged and respected. (4) Assessment should encompass all aspects of EOL care including physical symptoms, psychological well-being, social support and spiritual needs. An individualized care plans should be made and reviewed in multi-disciplinary meetings. (5) The EOL care plan should be reviewed on day 7 We retrospectively reviewed the clinical service provided to patients who attended from July 2017 till end of 2018. Cases with terminal malignancy on palliative care, with other terminal illness with documented advanced directives, post-cardiac arrest patients with profound hypoxic brain injury were recruited by doctors in Emergency Medicine (EM) Ward or referred from doctors from Accident and Emergency (A&E) Department in NLTH. The decision to initiate the “Withdraw/ withhold life-sustaining therapy and EOL care” plan was made by the A&E team including EM specialists and corresponding nursing staff participate in the EOL care meeting. EM doctor-in-charge and nurse-in-charge referred all the patients under EOL care to medical social worker (MSW), chaplaincy/ pastoral care, physiotherapist and occupational therapist. EM nurse in-charge should participate in formulating the individualized care plan for EOL care and review the care plan daily. Questionnaire on patient satisfaction has been started in the components of the EOL care service and staff support, environmental assessment after launching of EOL program in EMW (NLTH). The chief areas of evaluation include clinical management, pain relieve management, communication, emotional support, multi-disciplinary service arrangement and also level acceptability.
Result & Outcome :
In the period between July 2017 to end of 2018, 38 patients were recruited in EOL program. 19 male and 19 female patients. Total 16 questionnaires collected to EOL team, 19 surveys successfully interviewed by phone, cases were found in loss of follow-up. As a result, there are 33 out of 35 totally agreed for having satisfactory service. The mean of totally agree for receiving satisfactory EOL care is 95%. Conclusion End-of-life care service in A&E has been successfully initiated. In order to provide advanced and safe emergency nursing practice, a fast-tract referral and protocol-driven and multi-disciplinary care service were emphasized. EOL program can deliver a more prompt treatment to those who have advanced, progressive and irreversible disease and fail to respond to therapy and have a short life expectancy in terms of days.
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