L3 Bereavement and EoLC PDF

Bereavement and End of Life Care Component 12 © Department of Clinical Education & 1 Standards  End of Life Care & Bereavement - Component 12 Subjects covered during this training may evoke memories o...

Bereavement and End of Life Care Component 12 © Department of Clinical Education & 1 Standards  End of Life Care & Bereavement - Component 12 Subjects covered during this training may evoke memories of incidents that you have witnessed or been involved in. If you have any concerns please discuss with your Course Director/staff at the education centre. Support is available to all staff, more information is available on The Pulse LINC emergency on Call – 0207 922 7539 Staff Counselling Referral Line – 0800 882 4102 MIND Blue Light Infoline – 0300 303 5999 TRiM Assessment Wellbeing Hub – 0203 162 7554 © Department of Clinical Education & 2 Standards End of Life Care & Bereavement - Component 12 ‘ How people die remains in the memory of those who live on ’ -Dame Cicely Saunders © Department of Clinical Education & 3 Standards  End of Life Care & Bereavement - Component 12 Objectives Understand legal requirements and agreed ways of working to protect the rights of individuals at the end of life Understand advance care planning in relation to end of life care Provide support to individuals according to their end of life care plan Understand the action to take following the death of individuals Understand how to manage own feelings in relation to the dying or death of individuals Understand the effects of bereavement on individuals Support individuals that are bereaved. © Department of Clinical Education & 4 Standards  End of Life Care & Bereavement - Component 12 National Statistics 500,000 people die annually (England) Around 25 % are unexpected Majority of deaths are expected! Majority of people prefer to die at home © Department of Clinical Education & 5 Standards  End of Life Care & Bereavement - Component 12 LAS Statistics End of life care calls – April ‘21- March ‘22 17,262 …is this a true figure? End of life care EoLC codes incident themes: Incident code, 25 Illness codes: Resuscitation Palliative care, 88 Care plan viewing EoLC Cancer, 101 ED Conveyance EoLC Other, 102 © Department of Clinical Education & 6 Standards  End of Life Care & Bereavement - Component 12 Palliative Care vs End of Life Care ‘Palliative’ - From the Latin to cloak, i.e. cloaking symptoms. - A holistic approach to care which provides relief from distressing symptoms and allows patients to live as actively as possible, until death. ‘End of Life’ - Patients who are expected to die within the next 12 months. A challenging diagnosis even for experienced health care professionals. © Department of Clinical Education & 7 Standards  End of Life Care & Bereavement - Component 12 Recognition – useful tool SPICT TOOL  Found in SOCIAL TAB in EPCR  Tick box if indicators suggest in last 12 months of life  End of Life Care & Bereavement - Component 12 Advance Care Planning Voluntary process of discussing and planning future care for patients who have the capacity for decision making Done in anticipation of deterioration, Advance Care Plans outline their wishes and priorities for future care Plans are extremely valuable in deciding what is in the person’s best interests when they no longer have capacity for decision making © Department of Clinical Education & 9 Standards End of Life Care & Bereavement - Component 12 Advance Care Planning Lasting Power of Attorney (LPA) © Department of Clinical Education & 10 Standards  End of Life Care & Bereavement - Component 12 Advance Lasting Power of Advance Decision to DNACPR Statement Attorney (H&W) Refuse Treatment Can be located Yes Yes Yes Yes in UCP Can be located Yes Yes Yes Yes in the home Legally No Yes Yes No Binding May be Yes – mandatory for life Written Yes Mandatory sustaining treatment Yes Yes - for all decisions Yes – from May be verbal Yes No except life sustaining registered HCP treatment  End of Life Care & Bereavement - Component 12 Legal Requirements Human Rights Act 1998 Mental Capacity Act 2005 Lasting Power of Attorney Advance Decision to Refuse Treatment © Department of Clinical Education & 12 Standards  End of Life Care & Bereavement - Component 12 What are the benefits of ACP? For patients? For clinicians? For family members? © Department of Clinical Education & 13 Standards  End of Life Care & Bereavement - Component 12 ACP support – checklists and guidance ACP documents LPAs - LA068 ADRTs - LA067 A patient’s best interests LA066 A patient’s capacity - LA5/questions on ePCR LAS EoLC Guidance: Advance Care Planning © Department of Clinical Education & 14 Standards  End of Life Care & Bereavement - Component 12 Accessing patient’s ACPs: Urgent Care Plan Ability to make notes which are sent to the UCP creator DNACPR notifications Specific management for Contact numbers for HCPs and patient’s when in crisis significant individuals 15  End of Life Care & Bereavement - Component 12 Accessing the patient’s ACP: Urgent Care Plan Can also be found on scene: Care home notes District nursing/ Palliative care team notes Gold Standard Framework notes More widely UCP  End of Life Care & Bereavement - Component 12 Contact and support Contact IM&T to get UCP link UCP helpdesk & password reset 24/7: 0203 880 0285 General queries: [email protected]  End of Life Care & Bereavement - Component 12 Recognition of the dying person Neurological Respiratory Dulled senses Fluid build up/ secretions Confusion Reduced cough reflex Agitation Hypoxia Social withdrawal/rallying Recurrent infections Reduced GCS Cardiac Arrhythmias Reduced cardiac output Gastrointestinal Cyanosis Reduced food/fluid intake Constipation/ Diarrhoea Nausea/vomiting Renal Incontinence Toxaemia Muscle twitching End of Bed assessment: Cachexia, pallor, cyanosis, mottled skin/ extremities, irregular/ agonal breathing  End of Life Care & Bereavement - Component 12 Communication and breaking bad news Establish what the patient/carer/family understand about the diagnosis and present situation. ‘What have you been told about the condition?’ ‘What do you expect further treatments to be? Give a warning shot: ‘I am worried about him/her’ Deliver bad news, in small chunks, pause and let the information sink in – silence is okay Check their understanding and identify concerns © Department of Clinical Education & 19 Standards  End of Life Care & Bereavement - Component 12 Common symptoms patients experience Pain Agitation/Confusion Nausea & Vomiting Secretions Breathlessness Management: 1. Non pharmacological – reassurance, position, fan, environment 2. Pharmacological – anticipatory medicines may be prescribed and available on scene Can only be given by a paramedic © Department of Clinical Education & 20 Standards  End of Life Care & Bereavement - Component 12 Support the dying patient Hold their hand Position for comfort Talk to them, reassure Quiet environment Symptom control and mouth care Consider spiritual/religious needs Don’t take unnecessary observations Be aware they will be able to hear you! © Department of Clinical Education & 21 Standards  End of Life Care & Bereavement - Component 12 Support the family Encourage touching and talking Reassure, any emotional response is ok Facilitate what the family wish to do Talk about the patient, use her/his name Tell them it is ok to leave the room if they wish Explain / forewarn expected signs - not drinking, death rattle, sleepy, respiratory pattern. © Department of Clinical Education & Standards  End of Life Care & Bereavement - Component 12 What to do when a patient has died - Expected death (police not required) Positioning and moving Respect prior wishes – Very important Time for family/friends with patient alone Contact palliative care team/hospice Actions Following Verification of Death: Notify GP – will then provide death certificate If OOH family to contact their GP next working day Family to contact funeral director – leave LA3 © Department of Clinical Education & 23 Standards  End of Life Care & Bereavement - Component 12 Support and guidance for you Patient’s palliative care team Patient’s own GP Clinical Hub - Clinical Team Navigators APP-CC/UC 111/OOH GPs EoLC Appropriate Care Pathways © Department of Clinical Education & 24 Standards  In summary: six steps of end of life care  End of Life Care & Bereavement - Component 12 Looking after ourselves Peer support - debrief / talk to peers Take some time to process what happened – PD33 VOR ‘welfare’ if required LAS Wellbeing Hub – The Pulse , services/resources Personal bereavement – talk to trusted person /GP © Department of Clinical Education & 26 Standards  End of Life Care & Bereavement - Component 12 Bereavement Terms Bereavement- “the state of Grief – “The is a complex set having been bereaved” or of emotions experienced “the time we take to adjust after the loss of someone to having been bereaved close.” and to cope with the grief associated with that.” Bereaved – “To have been deprived of a close relative or friend through their death.” © Department of Clinical Education & 27 Standards  End of Life Care & Bereavement - Component 12 Bereavement There are generally four stages to Bereavement. These are: Accepting the loss Experience the pain of grief Adjusting to life without the person who has People may go died through these Putting less emotional energy into grieving and stages in different orders and at putting more into something new (moving on) different times. © Department of Clinical Education & 28 Standards  End of Life Care & Bereavement - Component 12 Bereavement There are also a range of factors that affect how people experience bereavement and grief, including: The nature of the loss Upbringing of the bereaved person Religious and spiritual beliefs Age of the bereaved person Relationship to the deceased Mental and physical health of the bereaved person © Department of Clinical Education & 29 Standards  End of Life Care & Bereavement - Component 12 The Grieving Process Grief is a normal process, there is no standard ‘Grief’. A bereaved person will have emotions that feel chaotic and out of control, but with time these will become less intense. There are different models of grief, but it is likely that people will experience: – Shock and numbness – Overwhelming sadness – Tiredness and exhaustion – Anger - can be toward person who has died, the illness, God or others. – Guilt - for being angry for something they did or didn’t say, or for not being able to help or stop their loved one from dying. © Department of Clinical Education & 30 Standards  End of Life Care & Bereavement - Component 12 Supporting the grieving process For most people family, friends and wider community will provide adequate support. Active listening and empathy are key in supporting someone with their loss. A smaller number need professional support. If someone is struggling with grief, they can access help following sources: – Their GP – The Samaritans – Charities helping to cope with bereavement – Hospice grief support systems – Grief counsellors © Department of Clinical Education & 31 Standards  End of Life Care & Bereavement - Component 12 Summary Pause and think… could it be end of life? Look for advance care plans/notes Call GP or specialist team for help Advice and information from Clinical Hub Think about what the patient would want along side what is the most appropriate care Think about the bereavement process and the support that can be offered It is important to reflect, talk and look after ourselves! © Department of Clinical Education & 32 Standards  End of Life Care & Bereavement - Component 12 LAS EoLC resources – Pulse Page Local EoLC Coordinators Education sessions/courses UCP support Reflections from practice LAS guidance:  Advance Care Planning  Recognition & Management of the Dying Patient  Medications at End of Life  Quick Reference Guide  End of Life Care & Bereavement - Component 12 ANY QUESTIONS? LAS Macmillan EoLC Team CONTACT FOR QUERIES, CONCERNS OR A COLD DEBRIEF AFTER A DIFFICULT EOLC SITUATION [email protected] © Department of Clinical Education & 34 Standards