Authors (including presenting author) :
Li HY(1), Kwok SS(1), Ng WF(1), Wong SL(1), Kwok TY(1), Ko PS(2), Lau SY(1)
Affiliation :
(1) End-of-Life Care Workgroup, Surgery Department, United Christian Hospital, (2) Palliative Care Services, Kowloon East Cluster
Introduction :
Second to Medical Department, the number of deaths in Surgery Department is significant. However, the standard of End-of-Life Care (EOLC) was inconsistent among the four surgical wards. In light of this, a care reminder for patients with advanced life-threatening illnesses was designed to guide frontline nursing staff to provide a standardized EOLC for terminally ill patients and their families. An audit on the effects of the reminder was conducted.
Objectives :
(1) To identify the overall compliance rate of the care reminder (2) To identify the compliance of individual care components of the care reminder (3) To identify the problems encountered when using the care reminder
Methodology :
A three-month audit was conducted from 1st September to 30th November, 2018 in the four surgical wards one year after implementation of the reminder. A self-designed audit form with eight care components was formulated. It includes (1) initiation of care reminder; (2) goal of treatment and care; (3) patient’s and family’s awareness and acceptance of the illness; (4) pain and symptom identification; (5) recognition on the needs of psycho-spiritual care; (6) making referral to multidisciplinary team when necessary (7) addressing the procedures and concerns surrounding death and (8) Grief support.
Result & Outcome :
All deceased patients (n=95) were recruited during audit period. We had achieved 86% overall compliance rate. The care reminder was successfully initiated in 95% of the deceased patients, and the reasons for the remaining 5% not using the reminder included sudden death and death within 24 hours after admission. 91% showed the effectiveness of communication to patients and their families regarding the goal of treatment, awareness and acceptance of the illness and allowing flexible visiting hours. Besides, 90% demonstrated compliance in identifying and monitoring the major or distressing symptoms and addressing psycho-spiritual needs. In 80%, appropriate referrals were made to Palliative Care Consultation Team or other allied health team staff. On the other hand, some nurses reported that they felt uneasy and had hesitation in talking about death related issues such as dealing with unfinished business and funeral issues. Conclusion: The audit showed positive result in using a standardized care reminder for terminally ill patients in acute surgical settings. Organizing regular education program to nursing staff on palliative care knowledge and skills is recommended. Besides cognitive concerns, dealing with the uncomfortable feeling towards death among health professionals is also necessary.
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