POLICIES & PROCEDURES ON END OF LIFE CARE

                                

                                   POLICIES & PROCEDURES ON END OF LIFE CARE

Preamble : 

In the last phase of life people seek peace and dignity. To help realize this, every person should be able to fairly expect the following elements of care from physicians, health care institutions, and the community.

 

Policy: To provide skilful nursing, gentle handling and utmost reverence to the body after death.

• Patients may have one or more cultural beliefs or personal wishes relating to death and dying; these must be respected.
• Infection risks do not increase after death. Death in hospital may necessitate by law the involvement of the registrar/legal authority.
• It is important that healthcare workers comply with legislation, the wishes of patients/relatives and continue to follow Standard Precautions and where necessary.
• Transmission Based Precautions to minimize any risk of cross-infection.

 

Core Principles for End-of-Life Care

 

Clinical policy of care at the end of life and the professional practice it guides should:

 

1. Respect the dignity of both patient and caregivers;
2. Be sensitive to and respectful of the patient's and family's wishes;
3. Use the most appropriate measures that are consistent with patient choices
4. Encompass alleviation of pain and other physical symptoms;
5. Access and manage psychological, social, and spiritual/religious problems;
6. Offer continuity (the patient should be able to continue to be cared for, if so desired, by his/her primary care and specialist providers);
7. Provide access to any therapy which may realistically be expected to improve the patient's quality of life, including alternative or non-traditional treatments;
8. Provide access to palliative care and hospice care;
9. Respect the right to refuse treatment;
10. Respect the physician's professional responsibility to discontinue some treatments when appropriate, with consideration for both patient and family preferences;
11. Promote clinical and evidence-based research on providing care at the end of life.

 

Identify the following:

• If the patient has any cultural or religious beliefs which necessitate alternative procedures to nurses undertaking Last Offices. If this is the case then follow the instructions for the specific religion guidelines.
• If the body of the deceased is likely to leak after death, a body bag will be required.
• If any special requests made before death, e.g. the keeping on of jewellery, clothes to be worn.
• If the eyes have been donated for corneal grafting.
• If there are any radiation precautions still in force.

 

PROCEDURAL STEPS:

 

Condition of the dead body is to be verified and recorded properly, before keeping the dead body inside the dead body bag.

 

Procedure:

 

S.No	Procedure Steps	Responsibility
	PHYSICAL PREPARATION OF DEAD BODY
	Eyes should be closed immediately as in sleep. If relatives have consented to	Primary nurse
	If the eyes are for donation, gently tape close the eyelids using Transpore tape	Primary nurse
	Body to be straightened with arms laid at the sides.	Primary nurse / attendent
	Mouth should be closed immediately.	Primary nurse / attendent
	Remove all support equipments	Primary nurse / attendent
	Give thorough sponging to the patient.	Primary nurse / attendent
	To change patient clothes.	Primary nurse / attendent
	Keep the head & chin in position.	Primary nurse / attendent
	Bandages may be used if necessary.	Primary nurse / attendent
	Plug nose and ears with cotton plug.	Primary nurse / attendent
	Cover the patient with new white bed sheet.	Primary nurse / attendent
	Attach an identity card to the dead body having name & IP No.	Primary nurse / attendent
	Allow the relatives to be with the body for a while. Arrange to meet the religious rites if possible.	Primary nurse
	Primary Nurse to follow the routine discharge procedure as per Discharge policy.	Primary nurse
	Primary Nurse to arrange for Mortuary / Dead body van if required.	Primary nurse
	If the deceased has dentures ensure they are in right place. Not for deceased of Jewish faith	Primary nurse
	Attach identification bands to a wrist and the opposite ankle of the deceased.	Primary nurse
	Both identification bands should contain the following information: Deceased’s Name, Hospital Number, date of birth, ward.	Primary nurse
	If the lower jaw drops down significantly, consider putting on a chin support by applying bandages.	Primary nurse
	Place an adult incontinence pad/diaper under the deceased.	Primary nurse
	If the deceased is to be viewed by relatives on the ward ensure there is no blood or body Wrap the patient carefully in a sheet and fasten with tape. Fluid leakage about the face.	Primary nurse
	Close all the orifices of the body with cotton plug.	Primary nurse
	If radiation restrictions are still in force, attach a sticker “RISK OF IONIZING DIATION” to the outside of the shroud.	Primary nurse
	Place the deceased in a body bag if the body is likely to leak, or if the patient has an infection / alert organism and it is indicated in table 1.	Primary nurse
	Remove gloves and plastic apron and wash hands. (Use new gloves for any additional clearing procedures to prevent direct contact with blood or body fluids or equipment contaminated with blood or body fluid).	Primary nurse
	If there is a risk of leakage or infection the porters will use gloves regardless of whether the body is in a bag. The attendees will wash their hands after handling a wrapped body. Complete nursing documentation. AFTER CARE Ensure all notes, laboratory reports and X rays are gathered together.	Primary nurse