Presentation on theme: "Case Discussions Challenges in End of Life Care 15/11/14 MRS M."— Presentation transcript:
Case Discussions Challenges in End of Life Care 15/11/14 MRS M
85 year old Care Home Resident Type 2 diabetes, leg ulcer Meds: PPI Statin, Metformin, + recent Amitriptyline, MST, Oramorph Social Orientated, alert, communicates with staff NOK – Nephew
Background Foot ulcer 6/12 care of DNs but mobile 8 th June: …lost weight, poor appetite, worsening foot pain Commenced MST, + Oramorph prn Late June: Still pain ?Neuropathic- Amitriptyline commenced Due review 1 st July by Community Geriatrician for A CP
30 th June – phone call – on call GP, Mon 2pm “Mrs M deteriorated over morning, not herself ” Visit In Bed, Difficult to rouse All Obs normal Looked Dry. General exam NAD Pupils reacting- Not co-operative for neuro exam, No obvious infection…… No urine to test LOOKED LIKE SHE WAS DYING
WHAT DO YOU DO NOW? ADMIT OR LEAVE IN NURSING HOME?? Staff want admission unless GP does DNACPR form and ACP immediately Nephew in a meeting. Staff say spoken to him. He would be keen for admission. Not able to disturb until meeting ends at 7pm Note – was due to have ACP discussion in a few days.
Discussion Unable to ask Mrs M her wishes No prior discussion recorded (due imminently) No family available to ask what Mrs M would have wished Patient best interests.. Benefits v burdens of courses of action.
WHAT HAPPENED NEXT? Arranged admission as sudden change even though appeared end of life…… Ambulance booked Nursing home staff happy, GP troubled. Later… Nursing Home phoned- managed to contact nephew who preferred to leave Mrs M in Home Unable to take anything orally, sub cutaneous meds arranged 2/7 died peacefully surrounded by family