Step | Content of the step |
---|---|
Discussions as the end-of-life approaches | Advance care planning discussions with residents and/or families are conducted to elicit wishes and preferences around end-of-life care. |
Assessment, care planning and review | A ‘Mapping Changes in Condition chart’ is used monthly by nurses and care assistants to plot changes (deterioration and improvement) in a resident’s physical condition. |
Coordination of care | Using a Palliative Care Register, residents who are identified as expected to live less than 6 months are discussed in detail during monthly multidisciplinary review meetings. A summary sheet is sent to physicians who were not able to attend the meeting. |
Delivery of high-quality care | Staff learns about symptom control and complex communication skills, with a focus on pain and depression. |
Care in the last days of life | The Last Days of Life checklist prompts and guides the care in the last days of life, with a focus on recognizing dying, communication with family, regular assessment of symptoms, anticipatory medication prescription, hydration, and psychosocial and spiritual support. |
Care after death | Reflective meetings following a death are held to support staff and encourage experiential learning. |