GUIDELINES ON THE MANAGEMENT AND

CARE OF A PATIENT WHO REQUIRES AN

APPROPRIATE ENVIRONMENT FOR END OF

LIFE CARE

University Hospital

Waterford

“With five minutes quality our families will never

forget us – with five minutes poor quality our

families will never forgive us”

(Fiona Murphy, Bolton and Wigan NHS foundation

2013)

University Hospital Waterford is a 403 bedded

regional hospital serving

Waterford,Kilkenny,Carlow, Tipperary and

Wexford

It is one of the centers of exellence for cancer

care.

Waterford Hospital has 15 wards with 4 single

rooms on each ward.

In 2014 a total of 462 patients died throughout

the hospital in various areas.

UNIVERSITY HOSPITAL

WATERFORD

STAFF OF 1,700 PEOPLE

403 INPATIENT BEDS

103 DAY PLACES

2,200 BIRTHS

It is widely accepted acknowledged that the

majority of cancer deaths occur in a

hospital.Likewise there is a growing belief that

the hospital envoirnment conveys a powerful

message and may have an impact on patient and

staff outcome”Ulrich et al,2004”

The body of evidence that informs ward design

policy recommends single bedded rooms on the

grounds of reduced infection risk,noise and

versatility.

A small survey of 50 patients using the specialist

palliative care unit in a regional cancer center

discovered that only 20% of patients would prefer

a single room,68%preferred to be in an open

area,12% had no preference.(Pease,Finlay,2002)

PATIENTS PERSPECTIVE

“If you are ill and just want quiet a cubicle is

great but if your brain is active and alive you

want a room where you can have conversation”

“The brightness and to see what is going on

around you and people going through the same

things you are going through not feeling isolated

basically”

(Rowlands,Noble,Palliative

Medicine,2008;22,768-774 )

The Palliative care department had a total of 263

deaths in 2014.

Almost 200 deaths in the hospital were not

known to the palliative care team.

50

14 14 12 126 7 6 5 5

2

0

10

20

30

40

50

60

<=24HRS 2 DAYS 9 DAYS 4 DAYS 5 DAYS 10-20 DAYS

20-40 DAYS

8 DAYS 7 DAYS 6 DAYS >60 DAYS

Length under Palliative Care <=24HRS

2 DAYS

9 DAYS

4 DAYS

5 DAYS

10-20 DAYS

20-40 DAYS

8 DAYS

7 DAYS

6 DAYS

>60 DAYS

IRISH HOSPICE FOUNDATION.

Most people die in wards with another 5 to 6

people in the ward

15% of beds in hospitals are in single rooms and

56% of patients died in a multi occupancy room

of 5 to 6 beds

28% of these were mixed gender bays

WORKING GROUP

Director of nursing

Bed management

Infection control

Palliative care cns

Nursing administration

End of life committee in UHW.

PURPOSE OF GUIDELINE

The purpose of these guidelines were to provide

university hospital staff with guidance should

there be difficulty in providing a patient with an

appropriate envoirnment for their end of life care

Due to limited amount of rooms not all unwell or

critically ill patients can be facilitated however a

patient whose death is imminent deserves that

we make every effort to facilitate an appropriate

envoirnment.

In University Hospital Waterford at any given

time there are numerous conflicting demands on

all hospital beds .In any given situation the bed

manager,infection control and senior nurse

manager must critically look at all demands risk

asses and make the best clinical decision they

can at the time.

INFECTION CONTROL

If there are difficulties achieving this infection

control ,bed management and senior nurse

management should meet to review the

situation.this will lead to the best outcome and

facilitate communication among all parties.

Patient risk and placement ,patients may be

cohorted together in a 3 bedded or 6 bedded bay

ideally on med 3 which is our dedicated isolation

ward.

Version 8-CT/MS/JL/GM/RL/LK/CB

DRAFT 8

Guidelines on the Management

and Care of a Patient who requires

an appropriate environment for

End of Life Care

PATHWAY

PATIENTS CONDITION CHANGING PATIENT FAMILY WISHES DOCUMENTATION BY CLINICAL LEAD NURSING STAFF APPROACH LINE MANAGER,SITE MANAGER,BED

MANAGER,INFECTION CONTROL

OPEN COMMUNICATION ,MAKE EVERY EFFORT TO GET A SIDE ROOM ,FAILING THIS A SPACE SHOULD BE CREATED TO PROVIDE AN ENVOIRNMENT THAT ALLOWS A PATIENT TO DIE WITH DIGNITY.

CONCLUSION

Policy is not a solution or an answer but it does

highlight the need for single rooms.

Awareness from hospital management ,bed

management,ward staff of need for side room.

Awareness from ward staff that patients can be

cohorted.

Highlighted the effect of moving a patient out of

bay and what it signified

CONCLUSION

In the absense of a side room next best thing is

creating a quiet space

Utilise empty bays

Use of treatment rooms

Check availability of sideroom else where in

hospital

Meet daily with senior nursing admin ,bed

management ward manager s and look at virtual

hospital,to highlight any patients at end of life.

OUTCOME

As a consequence of policy there is a pathway for

acquiring a side room for an appropriate patient

Greater awareness among hospital staff

Family /patient crucial to decision re side room

Opportunity to audit ,from here on

Family with complaint have been listened to and

acted on their complaint has been acknowledged

and responded to.

PALLIATIVE CARE RIPS LAST 2 WEEKS

12 patients rip

10 died in single rooms

2 died in 6 bedded.

THANK YOU ANY QUESTIONS??

REFERENCE

HOW DOES THE ENVOIRNMENT IMPACT ON

THE QUALITY OF LIFE OF ADVANCED

CANCER PATIENTS?A QUALITATATIVE

STUDY WITH IMPLICATIONS FOR WARD

DESIGN.PALLIATIVE

MEDICINE(2008);22,768-774

QUALITY STANDARDS FOR END OF LIFE

CARE IN HOSPITALS,HOSPICE FRIENDLY

HOSPITALS,2010