End of Life Care
WONG Chi Yip
KCC Nursing Consultant (Emergency Care), QEH
A&E is a place for rescue and saving people's lives in our mind. Palliative care or end of life care is not the job of A&E. Since there are patients facing imminent death in A&E, the End of life (EOL) programme has been launched at QEH A&E to serve these group of patients since 2010. The purpose of the EOL service in A&E is to give a place for patients and their relatives to have a quiet place to stay in the last moment of life. According to WHO, the palliative care is an approach that improves the quality of life of patients and families who face life-threatening illness, by providing pain and symptom relief, spiritual and psychosocial support to patients from diagnosis to end of life and bereavement.
QEH A&E started to offer EOL service in 2010. One treatment room was renovated to a single bed room (Osiris Room 晚晴室) in the emergency medical ward (EMW). Target patients are those who have reached the stage of imminent death due to unsalvageable medical or surgical conditions, whose death is expected within hours to several days. Patients from A&E would be admitted to the Osiris room directly if criteria are met. Owing to limited patients who fit the criteria when approaching A&E, those patients will be admitted to the general ward. In order to utilize the facilities, we accepted the consultation of EOL service from different specialties afterwards. The suitable cases would be transferred from wards to our EOL room for palliative care, not only from the A&E.
The EOL care which targets on symptom relief, spiritual and psychological support in time of deterioration. After discussing with the patient or patient’s relatives, they agreed not to further resuscitate even further deteriorate. The cases would be admitted to our Osiris room after the DNACPR form is signed. Doctors and nurses would formulate the plan for caring for the patient and his relatives. Investigations, unnecessary medications and resuscitation would be withheld. Symptoms of terminal illness would be reduced by medication. The use of morphine would help the patient to relieve the pain or dyspnea. Patients suffering from increased oral secretion or death rattles will be improved by Hyoscine. Midazolam or Haloperidol would be used in case suffered from agitation, restlessness or terminal delirium. Nausea, vomit or fever could be relieved by Metoclopramide or Panadol. Not only the patient’s symptom, non-pharmacological measures e.g. dim light, reduced noise, avoid restraints, allow familiar people around, psychological or spiritual support would be supported in the EOL room. Religious support e.g.(Christian, Buddhism, Catholic etc.) CD could be played through the CD player in the room. Positive feedback have been received from the patient’s relative in the satisfaction survey.
The physical layout and hospital design would facilitate the palliative care. In the future design of the new hospital in Kai Tak, one single room with facilities similar to Osiris room would be equipped in each ward therefore end of life service can be provided in different specialties. More patients and relatives can be benefit for this service.