Notes – End-of-Life Care/Palliative Care

End-of-Life Care/Palliative Care

Patient Safety Considerations

  1. Careful and thorough assessments should be performed to identify complaints not related to the illness for which the patient is receiving hospice or palliative care
  2. Care should be delivered with the utmost patience and compassion

Notes/Educational Pearls

Key Considerations

  1. Social interactions with family may affect end-of-life care
  2. Scene safety should be considered when deciding on management

Pertinent Assessment Findings

  1. Vital signs
  2. Pain score
  3. Neurologic exam
  4. Lung sounds

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914169 – Cardiac Arrest-Do Not Resuscitate
  • 9914171 – Cardiac Arrest-Special Resuscitation Orders
  • 9914177 – General-Exception Protocol

Key Documentation Elements

  • Interaction with hospice or palliative care provider
  • Confirmation of advanced directive or other advanced care documentation
  • Pain score if applicable

Performance Measures

  • If in patient in pain, pain score change
  • If patient is nauseated, symptom relief
  • If patient is dehydrated, symptom relief or vital sign change

References

  1. Canadian Prehospital Evidence Based Practice. https://emspep.cdha.nshealth.ca/TOC.aspx. Accessed April 28, 2017.
  2. Coyne PJ, Viswanathan R, Smith TJ. Nebulized fentanyl citrate improves patients’ perception of breathing, respiratory rate, and oxygen saturation in dyspnea. J Pain Symptom Manage. 2002;23(2):157-60.
  3. Farahmand S, Shiralizadeh S, Talebian MT, et al. Nebulized fentanyl vs intravenous morphine for ED patients with acute limb pain: a randomized clinical trial. Am J Emerg Med. 2014;32(9):1011-5.
  4. Shirk MB, Donahue KR, Shirvai J. Unlabeled uses of nebulized medications. Am J Health Syst Pharm. 2006;63(18):1704-16.