Planning for an Expected Death at Home An Initiative of The South - - PowerPoint PPT Presentation

Planning for an Expected Death at Home

An Initiative of The South East Palliative & End-of-Life Care Network Service Delivery Committee.

Palliative Care

• Care for those living with

life-limiting, life-threatening illness

• Advance care planning is recommended as

soon as you are able to introduce the topic to patient & family

Presentation Death Hospice Palliative Care

Model for Palliative Care

Frank Ferris Oct 2005

Therapies to modify disease End-of-life Care Therapies to relieve suffering and/or improve quality of life Bereavement Care

Planning for a Home Death

• Who pronounces death?
• Who is responsible for certification of death?
• Who does the family contact at time of death?
• What about the DNRC form?
• How do we help families prepare for death?
• Who makes sure everything gets done?

South East Local Health Integration Network Map

We Need a Plan!

Working group established under the direction

• f the Palliative & End of Life Care Network

Reported to the Service Delivery Committee of the Network Consultation with nurses, case managers, physicians, EMS, funeral directors

Do not resuscitate

• A plan of treatment is developed that reflects the

expressed wish of the patient (or consent of the substitute decision maker for the person who is not capable) that CPR is not in the patient’s plan

• f treatment.
• DNRC form is completed providing direction for

EMS practitioners

The Yellow Folder

Yellow Folder Contents

• DNRC Form
• Yellow Magnet
• Algorithm
• Guidelines
• Brochure When Death Occurs at Home
• A checklist for Case Managers in folders at CCAC

What do you do with the magnet?

• The magnet is a signal that the yellow folder is in

the home

• May be very helpful for EMS on a 911 call
• It is meant to be placed on the refrigerator door

The Algorithm

• A tool to assist with planning for pronouncement

and certification of death

• Nurses (RN or RPN) can pronounce death
• Only a physician or RN(EC) can sign a death

certificate

MD

• r

RN (EC)

• r

Medical Group Will not attend home to pronounce

• r

not available 24/7 Will attend home to pronounce and certify 24/7 Nurse pronounces MD or RN (EC)

• r Medical Group

will not certify within 24 hours of death Explore local options: Alternate MD or RN (EC)

• r Medical Group

to certify within 24 hours of death Funeral Home will accept nurse pronouncement and certification within 24 hours of death Funeral Home will not accept nurse pronouncement and certification within 24 hours

• f death

Explore local options: Alternate MD or RN (EC)

• r Medical Group

to attend home to pronounce and certify 24/7

EXPECTED DEATH IN THE COMMUNITY PLANNING TOOL

Following discussion with family and physician indicate/circle plan. Name____________________________ Date_____________________________ MD or RN (EC)

• r Medical Group

will certify as soon as possible (within 24 hours

• f death)

Determine how to get death certificate to Funeral Home after completion Patient’s Name_____________________

• Avoid calling the coroner unless there are

reasons to contact them

• Avoid transfer of the body to ER for

pronouncement and certification

• It is inappropriate to sign a death certificate prior

to the death

Guidelines/Checklist Family/Caregiver/Agency at Time of Death

• Completed with family/informal caregiver
• Numbers to call at time of death:
• professionals
• family/friends
• Cultural considerations at time of death

Brochure: When Death Occurs at Home

• Guide for informal caregivers
• What to expect; what to do
• Information re: appetite, swallowing, sleep,

confusion, breathing, bladder & bowel function, skin colour and temperature

• What will happen at the time of death

Who Introduces the Yellow Folder

• CCAC case manager
• Visiting nurse
• Consider PPS level & initiate discussion

Developed by Victoria Hospice Society

Who coordinates the process?

• The CCAC Case Manager will have a checklist
• f tasks to be completed.
• As each part of the process is completed, the

Case Manager will record it on the checklist

• The Case Manager will address any gaps in the

process

• Community Nurses to inform CM when yellow

folder is in the home

PALLIATIVE CARE PLANNING CHECKLIST FOR EXPECTED HOME DEATH

DATE (dd/mm/yy) TIME TASK YES NO N/A

• 1. Case Manager confirms which funeral home to use, and has permission to

phone a)Funeral Home _____________________ Phone# ___________________ b)Funeral Director ___________________ c)Alternative Out of Area Arrangements____________________________ _____________________________________________________________

• 2. Funeral home is aware that care plan includes home death and has

directions to the home

• 3. Funeral Home agrees to remove body without a completed death

certificate* * If answer is “No” a physician or RN (EC) must agree to go to home to certify death.

• 4. Physician or RN (EC) agrees to go to home to certify death

Physician or RN (EC) ____________________Pager # ________________ Phone # _____________________ After Hours # _____________________ Substitute Physician or RN (EC)_________________Pager # ___________ Phone # _____________________ After Hours # ____________________ On Call Physician_____________________ Phone #__________________

• 5. If answer to #4 is “No”, physician or RN (EC) agrees that the nurse will

pronounce death, allowing removal of body to funeral home. Physician or nurse practitioner agrees to provide death certificate to the funeral home within 24 hours (Record contact information in #4 above).

• 6. Physician or RN(EC) agrees that if all efforts to make contact fail at time
• f death, the process for the nurse to pronounce death will occur, as in #5
• above. * Not applicable if answer to #3 is “No”.
• 7. Case Manager has confirmed the plan with the nursing service provider
• 8. Case manager has shared the plan with all other service providers
• 9. A) Brochure “When Death Occurs at Home” provided to family

B) Family member/caregiver understands the procedure for home death

• 10. A) Client/family directives regarding resuscitation addressed

B) Client’s advance directives, if available, are documented and communicated

• 11. Confirmation that DNRC is completed and in the home
• 12. Copies of checklist to appropriate service providers

Physician Funeral Home Service Providers CASE MANAGER___________________________ PHONE # _________________ FAX # ___________________

1 of 1 Sept 2009

Client Label

Facilitation of planning for expected death in the home will result in:

• DNR status identified appropriately
• Plans for pronouncement & certification in place
• Family is supported through the dying process
• Avoidance of unnecessary calls to EMS

Questions? Thanks!