Guidelines on the Management and Care of a Patient who Requires an Appropriate Environment for End of Life Care (Presentation by University Hospital Waterford from Acute Hospital Network, March 2015) [AHN 27]

1. GUIDELINES ON THE MANAGEMENT AND
CARE OF A PATIENT WHO REQUIRES AN
APPROPRIATE ENVIRONMENT FOR END OF
LIFE CARE
University Hospital
Waterford

2. “With five minutes quality our families will never
forget us – with five minutes poor quality our
families will never forgive us”
(Fiona Murphy, Bolton and Wigan NHS foundation
2013)

5.  University Hospital Waterford is a 403 bedded
regional hospital serving
Waterford,Kilkenny,Carlow, Tipperary and
Wexford
 It is one of the centers of exellence for cancer
care.
 Waterford Hospital has 15 wards with 4 single
rooms on each ward.
 In 2014 a total of 462 patients died throughout
the hospital in various areas.

6. UNIVERSITY HOSPITAL
WATERFORD
 STAFF OF 1,700 PEOPLE
 403 INPATIENT BEDS
 103 DAY PLACES
 2,200 BIRTHS

7.  It is widely accepted acknowledged that the
majority of cancer deaths occur in a
hospital.Likewise there is a growing belief that
the hospital envoirnment conveys a powerful
message and may have an impact on patient and
staff outcome”Ulrich et al,2004”

8.  The body of evidence that informs ward design
policy recommends single bedded rooms on the
grounds of reduced infection risk,noise and
versatility.
 A small survey of 50 patients using the specialist
palliative care unit in a regional cancer center
discovered that only 20% of patients would prefer
a single room,68%preferred to be in an open
area,12% had no preference.(Pease,Finlay,2002)

9. PATIENTS PERSPECTIVE
 “If you are ill and just want quiet a cubicle is
great but if your brain is active and alive you
want a room where you can have conversation”
 “The brightness and to see what is going on
around you and people going through the same
things you are going through not feeling isolated
basically”
(Rowlands,Noble,Palliative
Medicine,2008;22,768-774 )

10.  The Palliative care department had a total of 263
deaths in 2014.
 Almost 200 deaths in the hospital were not
known to the palliative care team.

14. 50
14 14 12 12
6 7 6 5 5
2
0
10
20
30
40
50
60
<=24HRS 2 DAYS 9 DAYS 4 DAYS 5 DAYS 10-20
DAYS
20-40
DAYS
8 DAYS 7 DAYS 6 DAYS >60 DAYS
Length under Palliative Care <=24HRS
2 DAYS
9 DAYS
4 DAYS
5 DAYS
10-20 DAYS
20-40 DAYS
8 DAYS
7 DAYS
6 DAYS
>60 DAYS

15. IRISH HOSPICE FOUNDATION.
Most people die in wards with another 5 to 6
people in the ward
15% of beds in hospitals are in single rooms and
56% of patients died in a multi occupancy room
of 5 to 6 beds
28% of these were mixed gender bays

18. WORKING GROUP
 Director of nursing
 Bed management
 Infection control
 Palliative care cns
 Nursing administration
 End of life committee in UHW.

20. PURPOSE OF GUIDELINE
 The purpose of these guidelines were to provide
university hospital staff with guidance should
there be difficulty in providing a patient with an
appropriate envoirnment for their end of life care
 Due to limited amount of rooms not all unwell or
critically ill patients can be facilitated however a
patient whose death is imminent deserves that
we make every effort to facilitate an appropriate
envoirnment.

21.  In University Hospital Waterford at any given
time there are numerous conflicting demands on
all hospital beds .In any given situation the bed
manager,infection control and senior nurse
manager must critically look at all demands risk
asses and make the best clinical decision they
can at the time.

22. INFECTION CONTROL
 If there are difficulties achieving this infection
control ,bed management and senior nurse
management should meet to review the
situation.this will lead to the best outcome and
facilitate communication among all parties.
 Patient risk and placement ,patients may be
cohorted together in a 3 bedded or 6 bedded bay
ideally on med 3 which is our dedicated isolation
ward.

24. Version 8-CT/MS/JL/GM/RL/LK/CB
DRAFT 8
Guidelines on the Management
and Care of a Patient who requires
an appropriate environment for
End of Life Care

32. PATHWAY
 PATIENTS CONDITION CHANGING
 PATIENT FAMILY WISHES
 DOCUMENTATION BY CLINICAL LEAD
 NURSING STAFF APPROACH LINE MANAGER,SITE MANAGER,BED
MANAGER,INFECTION CONTROL
 OPEN COMMUNICATION ,MAKE EVERY EFFORT TO GET A SIDE
ROOM ,FAILING THIS A SPACE SHOULD BE CREATED TO
PROVIDE AN ENVOIRNMENT THAT ALLOWS A PATIENT TO DIE
WITH DIGNITY.

33. CONCLUSION
 Policy is not a solution or an answer but it does
highlight the need for single rooms.
 Awareness from hospital management ,bed
management,ward staff of need for side room.
 Awareness from ward staff that patients can be
cohorted.
 Highlighted the effect of moving a patient out of
bay and what it signified

34. CONCLUSION
 In the absense of a side room next best thing is
creating a quiet space
 Utilise empty bays
 Use of treatment rooms
 Check availability of sideroom else where in
hospital
 Meet daily with senior nursing admin ,bed
management ward manager s and look at virtual
hospital,to highlight any patients at end of life.

35. OUTCOME
 As a consequence of policy there is a pathway for
acquiring a side room for an appropriate patient
 Greater awareness among hospital staff
 Family /patient crucial to decision re side room
 Opportunity to audit ,from here on
 Family with complaint have been listened to and
acted on their complaint has been acknowledged
and responded to.

36. PALLIATIVE CARE RIPS LAST 2 WEEKS
 12 patients rip
 10 died in single rooms
 2 died in 6 bedded.

37. THANK YOU ANY QUESTIONS??

38. REFERENCE
HOW DOES THE ENVOIRNMENT IMPACT ON
THE QUALITY OF LIFE OF ADVANCED
CANCER PATIENTS?A QUALITATATIVE
STUDY WITH IMPLICATIONS FOR WARD
DESIGN.PALLIATIVE
MEDICINE(2008);22,768-774
QUALITY STANDARDS FOR END OF LIFE
CARE IN HOSPITALS,HOSPICE FRIENDLY
HOSPITALS,2010