Going Well…… Care of
the Dying in the Lyell ED
Dr Christine Drummond
Senior Palliative Care Consultant
Critical Care Servi...
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, prese...
Themes from our staff survey:
> We care, we want to be kind and do well, and
we feel stressed, upset and helpless when we
...
Dying in the ED Care Plan
Facilitates
> Holistic clinical care
> Education
> Audit
> Staff resilience
> Community partners...
Dying in the ED Care Plan
> Is supported by Clinical Guidelines relevant to
the ED environment
> Is evidence-based and pat...
Dying in the ED Care Plan
> A clinical assessment, led by the Consultant, in
consultation with the patient and loved ones,...
Dying in the ED Care Plan
> Interventions, procedures &
medications that do not aid in providing
comfort are ceased, unles...
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 ...
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...
Thank you for your attention
and the spirit in which you have
participated…….Go well
Christine.Drummond@health.sa.gov.au
Dr Christine Drummond, Lyell McEwin Hospital - Going well……Care of the Dying in the Lyell ED
Dr Christine Drummond, Lyell McEwin Hospital - Going well……Care of the Dying in the Lyell ED
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Dr Christine Drummond, Lyell McEwin Hospital - Going well……Care of the Dying in the Lyell ED

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Dr Christine Drummond delivered the presentation at the 2014 Emergency Department Management Conference.

The 2014 Emergency Department Management Conference explored areas such as how to improve access to care, clinical redesign, NEAT compliance, patient flow, point of care testing, geriatric care, and enhance the performance of Emergency Department.

For more information about the event, please visit: http://bit.ly/edmanagement14

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Dr Christine Drummond, Lyell McEwin Hospital - Going well……Care of the Dying in the Lyell ED

  1. 1. 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
  2. 2. Rapid, effective and kind care – a medical emergency
  3. 3. 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
  4. 4. 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
  5. 5. Dying in the ED Care Plan Facilitates > Holistic clinical care > Education > Audit > Staff resilience > Community partnerships
  6. 6. 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
  7. 7. 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
  8. 8. 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
  9. 9. Extraordinary things can happen in ordinary places…
  10. 10. Comfort Cupboard
  11. 11. 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
  12. 12. Partnerships > Lyell McEwin Regional Volunteer Association > Northern Adelaide Medicare Local > SA Palliative Care Council
  13. 13. Results so far……… > Well, I’m here, aren’t I……….
  14. 14. 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
  15. 15. Thank you for your attention and the spirit in which you have participated…….Go well Christine.Drummond@health.sa.gov.au
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