Managing end of life care amid Covid 19
As the situation with COVID-19 develops, we recognise that some patients will not respond to acute treatment and will unfortunately die from the condition. For other patients, their underlying health problems may mean it is not appropriate for them to receive active treatment and that their treatment is supportive/palliative from the outset.
In this situation, it is incredibly important that our patients receive good quality palliative care.
The Specialist Palliative Care Team have developed several documents to help support this.
Managing symptoms
Specific guidance on oxygen use in Care Homes
On May 1st an NHS England and NHS Improvement letter was released titled ‘COVID-19 response: Primary care and community health support care home residents’.
In the letter the statement below raised concerns across the respiratory community, regionally and nationally, as it was felt the actions described could lead to an increased risk to patients of oxygen being given inappropriately:
1a V support the introduction and use of remote monitoring of COVID-19 patients using pulse oximeters and other equipment … and prescription and supply of oxygen to care homes for treatment, where clinically indicated.
To ensure local teams were not confused, the decision was made to provide clear guidance around this statement, which can be found here. Our local policy was reviewed and a decision made to maintain our current guidance, with some additional criteria for issuing oxygen for those care home residents approaching end of life and for who admission to hospital for a suspected/confirmed case of COVID-19 is NOT in the patient’s best interests.
Communication
These simple communication guides could be used by professionals having COVID-19 specific advance care planning conversations in the community:
- Advance care planning conversations due to COVID-19
- Managing end of life care discussions for patients with COVID-19
- Talking to relatives: a guide to compassionate phone communication during COVID-19
Specific training on ACP during COVID-19 has been created and the associated resources can be found below:
- Summary of ACP and conversation skills remote training
- COVID-19 ACP slide pack
- A recorded training session can be viewed here
Additional resources and training is also available:
Verification of expected death guidance
The UK Government have issued specific guidance about verifying expected death in times of emergency, such as COVID-19, which can be found here.
Skills for Care have also produced a series of resources for the Adult Social Care workforce regarding verification of expected death with remote clinical support during COVID-19:
- VOED supportive guidance document
- Step-by-step VOED process infographic
- VEOD information pocket card
You can also view the associated webinar here.
Staff support and well-being
You can find support for managing your own wellbeing and supporting your colleagues on our dedicated wellbeing page here.
Several wellbeing apps are now free to NHS employees until March 31st 2020. Details can be found here.
If after following this guidance you still need further support and advice, please contact the Specialist Palliative Team:
Specialist Palliative Care Team
Monday to Sunday 9am – 5pm: 01924 543 801 (Bleep 249 via MYHT switchboard)
Out of hours please contact the On-call palliative care consultant via MYHT switchboard
Wakefield Hospice: 01924 331 400
Prince of Wales Hospice: 01977 708 868
EPaCCS training
Here you will find a page dedicated to the new Electronic Palliative Care Co-ordination System (EPaCCS), which was developed to ensure the care of people in their final year of life is coordinated and the individuals wishes are maintained. A series of training tools have been developed to ensure staff understand how to use this system, including both written and video guidance for different levels of staff.
System Management Guidance
You can find guidance documents to help with symptom management and prescribing anticipatory drugs during end of life care here.
