Decision-making and End-of-Life-care in Emergency (DandELinE) Pathway – decision support flowchart outlining the process which includes:
- Identifying patients who are nearing end of life or imminently dying.
- Discussing treatment options with the patient’s Substitute Decision Maker (Enduring Power of Attorney (EPOA) / Statutory Health Attorney).
- Documentation of discussions and outcomes.
- Implementation of the Care Plan for the Dying Person.
- Advice regarding medication for pain and symptom management.
- Disposition planning and transfer of the patient to the preferred transfer or discharge destination.
- Bereavement support for carers and staff.
DandELinE Resource Trolley – ‘clinical care’ trolley containing appropriate and required end-of-life care equipment and resources including door signs with the purple tree, Handover Bags for deceased patient belongings and the “When Someone Dies” booklet.
Increased capacity for ED staff – education and simulation training in the use of palliative care resources including, Niki pumps, Surefuser, Advance Care Planning documents and The Viewer.
Hand-Crafted Quilts – donated by the local quilting group and already available for patients receiving treatment in the Cancer Care Centre, these quilts are now available in the DandELinE Resource Trolley to help provide a beautiful, less ‘sterile’ environment for the dying patient.
DandELinE Work Place Instruction - designed to support the staff in the SCUH ED when making decisions regarding the validity of providing life-sustaining measures for patients at - or nearing - end of life.
DandELinE Medication for Symptom Management WPI – Prescribing Guide for the Dying Patient using evidenced-based best practice guidelines.
Implementation of the Care Plan for the Dying Person - Commenced in the ED, this care plan supports transition of care and facilitates clinical handover in instances where the patient is transferred to another ward / facility.
Interdepartmental collaboration supporting appropriate and person-centred disposition planning / transfer - Patient preferences (including religious or cultural preferences) are given priority when determining where best to care for the dying patient. Every effort must be made to quickly accommodate the patient in the most suitable area or preferred location for their end-of-life care. Options include:
- Returning to home / usual place of residence, supported by Palliative Care community follow-up.
- Admission to hospital / Palliative Care Unit (Dove Palliative Care Unit).
- Single room in the Short Stay Unit in ED - for those patients who are imminently dying.
Alternative transport for discharge – agreement to utilise the SCHHS Non-Urgent Non-Ambulance (NUNA) vehicle to transport patient home / usual place of residence, to Dove Palliative Care Unit or another SCHHS facility.
Staff survey – SCUH ED staff participated in a survey from The Palliative Care Evaluation Tool Kit: A compendium of tools to aid in the evaluation of palliative care projects. The survey assessed views about death and dying, attitudes towards palliative care and helped direct further training requirements.