Caring House The Smarties Series Care Planning for Smarties 1. The - - PDF document

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Caring House The Smarties Series Care Planning for Smarties 1. The - - PDF document

Oct 06, 2022 13 likes •128 views

Caring House The Smarties Series Care Planning for Smarties 1. The Six Keys to Care Planning Success 2. Who Ya Gonna Name? Plus Advance Directives 101 Care Lingo Decoded Plus CA End of Life Option Act 3. What Ya Gonna Tell Em? 4. Ive Been

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Providing peace, comfort and support to men and women at the ends of their lives

Caring House

Care Planning for Smarties Care Lingo Decoded Plus CA End of Life Option Act October 16, 2018

The Smarties Series

  • 1. The Six Keys to Care Planning Success
  • 2. Who Ya Gonna Name? Plus Advance Directives

101

  • 3. What Ya Gonna Tell Em?
  • 4. I’ve Been Named. How Do I Do an Amazing

Job?

  • 5. Care Lingo Decoded. Plus California’s End
  • f Life Option Act

Background

Ellen Gorbunoff, RN Ed Long, JD Handouts Time Questions

Handouts, Slides and More

You can get all class materials and be notified about future classes by signing up at

YourCaringHouse.org/materials

Core Concepts

  • 1. You have a right to decide whether to
  • - start,
  • - decline or
  • - stop

available medical treatment (“care decisions”).

  • 2. You have a right to name another

person to make care decisions for you.

Success as an Agent

Success as an Agent is 75% preparation. The other 75% is caring.

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What is Death?

Jahi McMath case

Neurological Death Cardiopulmonary Death

Irreversible cessation of function of

Circulatory (heart and blood flow) and Respiratory (breathing)

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POLST

Physician Orders for Life-Sustaining

Treatment (POLST)

What is it? Who creates it? When should it be done?

Person is seriously ill or frail and MD wouldn’t be surprised if person died within a year

NNNY (not now, not you)

POLST Lingo

CPR / DNR / AND

CPR Background

CardioPulmonary Resuscitation Cardio (heart) and Pulmonary (lungs) For when heart stopped or breathing

stopped

CPR Background (cont’d)

Originally for accidents or surprises Has become standard in hospitals and

nursing homes

Can involve

Chest compressions Mouth-to-mouth Electric shock (defibrillation) Intubation and respirator

CPR Background (cont’d)

After CPR, overall 15.2% survived to

hospital discharge

But, less than 2% survived to hospital

discharge if already

Had more than two medical problems or Unable to live independently or Had a terminal disease

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More Info on CPR

Hard Choices for Loving People, by Hank

Dunn

At hardchoices.com See Chapter One – Cardiopulmonary Resuscitation

DNR and Codes

DNR (do not resuscitate) DNAR (do not attempt resuscitation) AND (allow natural death) Full Code = use all interventions to bring

be back

Code Blue = page in a hospital calling

team to do CPR

CPR Video

American Heart Association demonstration

  • f in-hospital CPR.

A training video, using a dummy. Warning. This may be disturbing.

CPR Video Artificially Administered Nutrition

Hydration? Fluids? ANH (Artificial Nutrition and Hydration) Trial period (Time-limited trial)

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ANH Use Positive Examples

Otherwise healthy, intestine failure (IV

feeding)

Stroke causing inability to swallow, body

  • therwise functioning, believed/hoped will

recover ability to swallow

Trauma to throat or esophagus (car

accident) with expected “normal” life

Principal ANH Approaches

Nasogastric (NG), Nasoduodenal (ND),

Nasojejunal (NJ) tubes (nose to . . . )

Gastric (G), Gastrojejunal (GJ) and Jejunal

(J) tubes (through the skin to . . . )

Total Parenteral Nutrition (TPN) bypasses

the digestive system and drips through an IV into a vein

More Info on ANH

Hard Choices for Loving People, by Hank

Dunn

At hardchoices.com See Chapter Two – Artificial Hydration and Nutrition

About Caring House

The first and only non-medical home in

Los Angeles County totally focused on end-of-life care

An IRC 501(c)(3) nonprofit Volunteer originated, professionally

staffed, volunteer supported

Revenues from resident/family payments

and community donations

Jose’s Story

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POLST (Section B)

Climbing the steps

POLST (Section B)

1 2 3

Section B, Step 1

Step 1 Comfort-Focused Treatment Primary goal of maximizing comfort Includes pain management, oxygen, suctioning, airway clearing, etc.

Pain

Pain

 “A physical or emotional experience due to damage.”

Suffering

"A state of severe distress; related to the meaning of the experience to the person."

Pain

Impacts quality of life of person and family Severe pain is draining and can affect

mood

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The Pain Scale

Pain and Suffering Pain Scale

Opioids

Or opiates, a class of drug Include morphine and codeine (from

  • pium poppies)

Include Vicodin, Percodan, oxycodone,

heroin

Use for serious pain and to ease feeling of

shortness of breath

Opioids

About addiction

Data: 9% will misuse / become addicted End-of-life experts focus on pain relief and not concerned about addiction

About “hastening death”

If used properly, do not hasten death

Climbing the steps

POLST (Section B)

1 2 3

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Section B, Steps 1 + 2

Step 2 Selective Treatment Goal of treating medical conditions while avoiding burdensome measures Adds to below: medical treatment, IV antibiotics and IV fluids, noninvasive airway pressure, etc. Step 1 Comfort-Focused Treatment Primary goal of maximizing comfort Includes pain management, oxygen, suctioning, airway clearing, etc.

Climbing the steps

POLST (Section B)

1 2 3

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Section B, Steps 1 + 2 + 3

Step 3 Full Treatment Goal of prolonging life by all medically effective means Adds to below: intubation, respirator, cardioversion, etc. Step 2 Selective Treatment Goal of treating medical conditions while avoiding burdensome measures Adds to below: medical treatment, IV antibiotics and IV fluids, noninvasive airway pressure, etc. Step 1 Comfort-Focused Treatment Primary goal of maximizing comfort Includes pain management, oxygen, suctioning, airway clearing, etc.

Intubation

Medical procedure Plastic tube into throat, trachea (windpipe) Endotracheal tube (ET tube) Ventilator (or respirator) – a machine

connected to the ET tube to assist or fully breath for patient

Renal Failure and Dialysis

Renal Failure

Kidneys fail to perform normal functions (chemical balance, removing waste and toxins from the blood).

Dialysis

Uses a machine to remove waste and toxins from the blood.

“Life Support”

Keeps the body alive by helping with bodily functions

Breathing: Ventilator Heart: Defibrillation and/or medication Kidney: Dialysis Swallowing/digestion: ANH

Discharge Planning

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Discharge Planning (cont’d)

Start discharge planning

  • n or before the day of admission

Discharge Planning (cont’d)

When, What, Where, Who?

When move to the next level? What services and equipment needed? Where can services be provided? Who will provide the care?

Discharge Planning (cont’d)

Challenges:

MDs don’t know MDs don’t tell Too much care vs. too little

Discharge Planning (cont’d)

Role of Agent:

Be proactive Obtain and review Written Discharge Plan Consider appealing the discharge order

Better to stay, or better to go?

End of Life Option Act

Act authorizes

an adult who is terminally ill and mentally competent to request, obtain and use an aid-in-dying drug.

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Questions for You

The Act is a law of the State of California. Circumstances arguing for the law? Why need a law?

EOL Option Act - Eligibility

Resident of California Prognosis of six months or less remaining

life

Able to make own decisions Able to self-administer: eat, drink or

swallow drug

EOL Option Act - Steps

Minimum of six steps

First oral request to MD #1 Second oral request to MD #1

At least 15 days after first request

Witnessed written request to MD #1 Private discussion with MD #1 Meeting and confirmation by MD #2 Document within 48 hours before drug use

EOL Option Act – 2017

577 were prescribed EOL drug 374 died after taking the EOL drug 68.5% had cancer 50.8% female; 47.1% male; 2.1%

unknown

90.4% age 60+; 66.9% age 70+

More Info on EOL Option Act

Coalition for Compassionate Care of

California

at coalitionccc.org

California Board of Registered Nursing

Overview of Act at RN.ca.gov/endoflife.shtml

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Series 10 Top Take-Aways

  • 1. Advance care planning is for all adults –

not just those older than me.

  • 2. People-work before paperwork.
  • 3. Choose the best Agent for you.
  • 4. Figure out your wishes, values and views.
  • 5. Communicate your wishes, values and

views.

Series 10 Top Take-Aways

  • 6. Two monologues do not equal a dialogue.
  • 7. Stay up to date – Life brings changes.
  • 8. Focus on goals of care.
  • 9. Time-limited trials are crucial.

10.Success as an Agent is 75% preparation;

the other 75% is caring.

Handouts, Slides and More

You can get all class materials and be notified about future classes by signing up at

YourCaringHouse.org/materials