Tag Archive for: dept-NRS

End of life care

This topic is very interesting to me because my grandparents are getting older. My grandma just went through a difficult chemo and radiation cancer treatment. A year later she is doing much better but there were some tough months where the family was trying determine where she was going to live and who was going to help her. She wanted to just go home and not have any help. They did find a balance but it has created a lot of talk within our family about end of life care. My mom, after trying very hard to get her mother to move closer to one of her children and only getting extreme resistance, has told me sisters and I, when she gets older she will move closer to one of us. Sounds great right now but circumstances might be different if she is really sick and needing a lot of medical care and even more challenging if insurance didn’t cover most of it. What if the natural order of end of life doesn’t follow suit. Then what? Those are very hard discussions to have with your family.

There is a very good podcast with Freakonomics that I recently listened to called “Are you ready for a glorious sunset?” It discusses the reality of end of life care and the cost of living your last few months. One of the most interesting guest on the show was a doctor and he said he would not want all the tests and days in the hospital. He believed a financial incentive for patients who didn’t forgo end of life treatment was a good idea for the patient and the family. Go on one last trip, buy a house for their family or buy that last dream sports cars. On paper that seems very desirable but there are some tricky aspects. I think it also comes down to the family making life saving measures of someone they cherish without fully knowing the costs. In moments of dying loved ones, cost isn’t the issue but maybe it needs to be information that is available to the decision makers.

I hope that I can have more discussions with my parents before it becomes a tricky decision making process.

http://freakonomics.com/2015/08/27/are-you-ready-for-a-glorious-sunset-a-new-freakonomics-radio-episode/

The topic on end of life care is always a sensitive subject for individuals because even though everyone knows that death is an inevitable part of the journey in life, it is an avoided topic due to the fear, sadness and grief that it brings to an individual, a family and even to a whole community. I believe that the topic of end of life is totally driven by the person’s beliefs and values.

Personally, I have not spent much time thinking about the matter, partly because I am young and the thoughts that currently occupy me are about loving God, enjoying life to the fullest, loving my family, having a successful career, and eventually starting my own family. However, if I were to decide now on what I would want in my living will and health proxies, I would definitely want the healthcare team to do everything they can to resuscitate me. This is because since I’m a fairly young individual, I believe I have a better prognosis if ever was in a situation where I was critically ill. In regards to who I can lean on to help me make crucial decisions regarding my care and life, I would choose both my parents in assisting me making the right decisions. I believe that both my parents would make the right decisions because I know that all they want is what is best for me. When my parents and I had this type of discussion, they actually voiced their opinion that yes, they would choose being resuscitated and have the healthcare team do everything they can to maintain life, instead of allowing the person to become DNR.

Like other families, our conversation was not smooth sailing because as previously mentioned, death is a sensitive topic for people to discuss.On the contrary, my classmates and I have actually discussed the topic as part of an assignment and we were able to talk about it without any sense of uneasiness.Based on my experience, I believe that in order for the discussion of end of life to be less stressful, it must be brought up at a time where everyone is at a place where their hearts and minds are not occupied with other stressful things in life. This is because bringing up this topic where people are not in a place of comfort will further add a burden to their hearts.

(Photo retrieved from: https://www.pinterest.com/pin/505599495637390281/)

I think the best way to address sepsis conditions is to PREVENT IT! We as healthcare providers take many precautions for our patients, but we can take it to another level with sepsis prevention protocols. Mortality is HIGH in sepsis conditions, from 30%-60%, so prevention is crucial and can save lives. In researching sepsis prevention, I found the following points and interventions:

• Hand Hygiene and aseptic technique as per protocol
• Avoid trauma to mucosal surfaces that can be colonized by bacteria
• Use Prophylactic topicals and sprays to prevent nosocomial infections
• Attention to DVT
• Note: Protective environments for patients at risk have not been considered successful because most infections have endogenous origins.
• Prevention of ventilator-associated pneumonia:
  • Use sedation vacations and bundle protocols:
    • Elevate HOB
    • Peptic ulcer prophylaxis
    • Preventing oral-tracheal contamination
    • Use of continuous-suctioning endotracheal tube
    • Perform oral care every 2 hours
  • Prevention of venous catheter-related bloodstream infections (Central Line Bundle):
    • Use maximum barrier insertion precautions and daily review of line necessity/removal
  • Surgical site care:
    • Pts with surgical site infections are 60% more likely to be in ICU, spend 7+ more days in hospital and 2x mortality rate; avoid shaving and give prophylactic antibiotics 1 hr prior to procedures. Maintain aseptic technique when changing dressings; pay close attention to normothermia and blood glucose control.
  • Prevent UTIs:
    • 25%-40% of UTis occur in pts with foley > 7 days;
    • Maintain aseptic technique, dependent drainage, minimize manipulation of drainage system.

It is interesting to note that there is contradicting information regarding patient isolation and if it is beneficial to patients, as most infections are considered to have endogenous origins.

I remember a senior last year whose project included tallying healthcare workers as they entered/existed a patient’s room to see if they performed proper hand hygiene. The fact that she observed any percentage of non-compliance shows that the simplest preventions can be overlooked. If a nurse cannot remember protocols, a flow-chart or check list should be followed. Additionally, printed “bundle” protocols can usually be found in every facility.