Hospital staff told to discuss end of life care

Mary Kiely, consultant in palliative medicine at Calderdale and Huddersfield NHS Foundation Trust
Mary Kiely, consultant in palliative medicine at Calderdale and Huddersfield NHS Foundation Trust

DOCTORS and nurses at Calderdale Royal Hospital have been urged to talk to patients about their end of life care.

For patients at the end of their lives, health professionals can make a decision not to perform CPR.

If appropriate, a DNACPR - do not attempt cardio-pulmonary rescuscitation - can be made when performing CPR on a patient would be considered traumatic and futile.

Hospital chiefs say it is good practice to inform patients and their relaitves such a decision has been made, while emphasising other treatments will be available.

A region-wide form to record a DNACPR decision, which is filled in and goes home with the patients, has been in use for a year.

But several audits have shown the decision was discussed with patients or relatives in only 36 per cent of cases at Calderdale and Huddersfield NHS Foundation Trust.

Now health professionals are being urged to have that conversation with patients and their families to improve end of life care.

Mary Kiely, consultant in palliative medicine, said: “Many patients know their outlook is poor bit it is a relief for them to know that when they die, they will be kept comfortable. The difficulty for doctors is that they are not used to having this conversation and death is seen as a failure. What I find works is to tell patients what care and help will be given as well as the fact that CPR is not helpful when someone dies.”

There have been instances where families have discovered the completed form only after discharge home, without any sensitive conversation.

Dr Kiely said this was unacceptable and added: “Doctors must have these conversations with patients or it can make a difficult situation much worse.

“If the relatives aren’t aware, they will panic at home, ring 999, and risk and inappropriate readmission to hospital. “Much still needs to be done to make sure patients are well-informed and that the care they receive at the end of their lives is the best it can be.”

The trust is developing ways to improve the proecess such an electronic discharge summary, a screensaver reminder and an educational DVD.