Presentation on theme: "Planning for an Expected Death at Home"— Presentation transcript:
1Planning for an Expected Death at Home An Initiative of The South East Palliative & End-of-Life Care Network Service Delivery Committee.
2Palliative Care Care for those living with life-limiting, life-threatening illnessAdvance care planning is recommended as soon as you are able to introduce the topic to patient & family
3Model for Palliative Care 3/22/2017Model for Palliative CareFrank Ferris Oct 2005Therapies to modify diseaseEnd-of-lifeCareHospice Palliative CareThe diagonal line is dashed to indicate that it is never really straight and that instead the degree to which curative and palliative interventions are employed is highly variable along the illness trajectory. The end-of-life phase is a relatively small portion of the continuum.PresentationDeathTherapies to relieve suffering and/or improve quality of lifeBereavementCare3
4Planning for a Home Death Who pronounces death?Who is responsible for certification of death?Who does the family contact at time of death?What about the DNRC form?How do we help families prepare for death?Who makes sure everything gets done?
6We Need a Plan!Working group established under the direction of the Palliative & End of Life Care NetworkReported to the Service Delivery Committee of the NetworkConsultation with nurses, case managers, physicians, EMS, funeral directors
7Do not resuscitateA plan of treatment is developed that reflects the expressed wish of the patient (or consent of the substitute decision maker for the person who is not capable) that CPR is not in the patient’s plan of treatment.DNRC form is completed providing direction for EMS practitioners
13The AlgorithmA tool to assist with planning for pronouncement and certification of deathNurses (RN or RPN) can pronounce deathOnly a physician or RN(EC) can sign a death certificate
14EXPECTED DEATH IN THE COMMUNITY PLANNING TOOL Patient’s Name_____________________Will attendhome to pronounceand certify24/7MD or RN (EC)or Medical Groupwill certify as soon as possible (within 24 hours of death)MDorRN (EC)Medical GroupWill not attendhome to pronounceornot available 24/7NursepronouncesFuneral Home willaccept nurse pronouncementandcertification within24 hours of deathFuneral Home willnot accept nurse pronouncementand certificationwithin 24 hoursof deathMD or RN (EC)or Medical Groupwill not certify within24 hours of deathFollowing discussion with familyand physician indicate/circle plan.Name____________________________Date_____________________________Determine how toget deathcertificate toFuneral Homeafter completionExplore local options:Alternate MD orRN (EC)or Medical Groupto attend hometo pronounce andcertify 24/7Explore local options:Alternate MD or RN (EC)or Medical Groupto certify within24 hours of death
15Avoid calling the coroner unless there are reasons to contact them Avoid transfer of the body to ER for pronouncement and certificationIt is inappropriate to sign a death certificate prior to the death
16Guidelines/Checklist Family/Caregiver/Agency at Time of Death Completed with family/informal caregiverNumbers to call at time of death:- professionals- family/friendsCultural considerations at time of death
17Brochure: When Death Occurs at Home Guide for informal caregiversWhat to expect; what to doInformation re: appetite, swallowing, sleep, confusion, breathing, bladder & bowel function, skin colour and temperatureWhat will happen at the time of death
18Who Introduces the Yellow Folder CCAC case managerVisiting nurseConsider PPS level & initiate discussion
20Who coordinates the process? The CCAC Case Manager will have a checklist of tasks to be completed.As each part of the process is completed, the Case Manager will record it on the checklistThe Case Manager will address any gaps in the processCommunity Nurses to inform CM when yellow folder is in the home
22Facilitation of planning for expected death in the home will result in: DNR status identified appropriatelyPlans for pronouncement & certification in placeFamily is supported through the dying processAvoidance of unnecessary calls to EMS