The essential elements of the Dying Friendly Hospital can be found under these headings: Clinical Practice, Policy & Procedures, Staff, Family / Carers, Community. The two overarching themes are Culture and Communication. I will introduce these here and will expand upon them in future postings.
Culture refers to the value set and behaviours evident in the organisation that is the hospital. To be Dying Friendly the organsation needs to accept care of the dying as a core activity, and needs to value that activity. Regardless of the entry point (Emergency or direct admission), regardless of the setting (medical, surgical, critical care etc), a collective commitment to quality end of life care lies at the heart of a Dying Friendly hospital culture. This is "owned" by senior and junior clinical staff, as well as support services such as administration, catering and cleaning. (Side note - we have many "non-clinical" employees in our busy clinical areas who are exposed to dying and death. Do we prepare them for that and support them?)
The second meta theme is communication. The Dying Friendly Hospital is a place where the right information is sought in a compassionate and sensitive manner, and then is documented and referenced in such a way that those involved in care are aware of it. Further, the dying person and family / carers are not imposed on repeatedly to re-state information already provided. The flow of information is equally important where agreed rapid discharge is undertaken.
Elements
Clinical Practice
The Dying Friendly Hospital is committed to, and demonstrates, best clinical practice in the care of the dying. This also includes diagnosis of dying and differentiating it from reversible clinical deterioration. After around fifty years of the modern hospice movement there is ample evidence and consensus on best practice in palliative and end of life care. It remains puzzling why this is still not universally recognised by a range health care professionals.
Policy & Procedures
The Dying Friendly Hospital will have Policy and related procedures in place that ensure timely responses to end of life scenarios. Policy frameworks, which reflect local Culture, serve to provide guidance for the operations of an organisation. Advance Care Directives will be identified and incorporated into the plan of care. Medications relevant to end of life care support will be accessible 24/7. Where structurally possible single rooms will be utilised. Flexible family visiting arrangements will be supported. Rapid discharge processes will be supported where indicated.
Staff
The staff of the Dying Friendly Hospital will reflect the organsational culture and will have the knowledge and skills required to deliver optimal end of life care within their experience set and scope of practice. The Dying Friendly Hospital will also have its own Specialist Palliative Care workforce providing consultation services to all Hospital areas, supporting other staff in their provision of care. Even where a Palliative Care Unit or Hospice exist the majority of deaths will occur in the remainder of the Hospital, making a Palliative Care Hospital Consultation Team an essential service.
Family / Carers
The Dying Friendly Hospital will practice person centered end of life care, and will be sensitive to the needs of the dying person's family / carers. Communication with family / carers will incorporate the four "Cs": Clarity, Currency, Consistency and Compassion.
Community
The Dying Friendly Hospital will engage in health promotion activities that seek to normalise dying in the community it services, and will facilitate ongoing bereavement support as a health service provision.
More later.
No comments:
Post a Comment