FROM NFR TO AND: A POSITIVE APPROACH TO END OF LIFE CARE DISCUSSIONS. Issue 2 (1st June 2013)

• Record Type: Journal Article
• Authors: Frost, J; Campbell, K
• Is Part Of: BMJ supportive & palliative care. Volume 3:Issue 2(2013)
• Page Start: 277
• Page End: 278
• Publication Date: 2013-06-01
• Subjects: Palliative treatment -- Periodicals; Terminal care -- Periodicals; 616.029
• DOI: 10.1136/bmjspcare-2013-000491.137
• Languages: English
• ISSNs: 2045-435X

Abstract

Abstract : Background: We identified problems with paediatric end-of-life discussions, including language, content and location of documentation and information sharing with paramedics. Aim: To improve communication between clinical staff and between clinical staff and families about end of life care choices. Methods: We developed and implemented a novel approach: the Allow a Natural Death Policy and form. We collaborated with the NSW Ambulance Service to develop a system to communicate care choices to paramedics. Results: We audited the medical records of 43 children who died at CHW January–September, 2011. The results were: 15 (35%) did not have any information about end of life care choices 28 (65%) had end of life care choices documented Where no End of Life Care choices were documented: 10 (66%) were Coroners cases 8 (53%) had an admission of ≤1 day 8 (53%) died in PICU 6 (40%) died in Emergency Department 1 (7%) died in an inpatient ward Compliance with completing the AND was high, with the following sections completed 100%: Patient ID sticker FACS information Interpreter information Goals of care Response section Standing order section Medical Officer details Paramedic data is yet to be audited. Discussion: This project was well received by clinicians, paramedics and families. The audit demonstrated successful implementation. Conclusion: Focussing on the positive choices for care, rather than the withdrawal of care, has made difficult discussions easier and junior staff clear guidelines.