The Wesley Hospital palliative care service provides care to approximately 850 inpatients a year. Approximately 60 per cent of those patients are discharged, with a small percentage of patients requesting to go home – deteriorating or for terminal care.
Patients will often have symptom issues – pain, dyspnoea, anxiety and/or excessive secretions to name a few. As we know in the palliative care of patients, subcutaneous continuous infusions via a NIKI pump are often utilised to deliver twenty-four hour delivery of symptom medication. There is also the need for breakthrough medication to be administered, often by subcutaneous injection.
In hospitals and other health facilities, nurses provide care and administer medications, but for those at home, it is left to family and friends – making breakthrough medication difficult to manage if it is not administered orally.
For the past year, our service has been able to discharge many patients requesting to die at home. This has largely been due to the utilisation of the caring@home package for carers.
Members of the palliative care team and Registered Nurses on the ward educate family members to draw up and give subcutaneous symptom management medications to their loved ones at home. caring@home printed literature and USB training videos about how to manage and give medicines are given to the family in hospital to allow them time to read and ask questions. The caring@home package for carers is then sent home with the family once the patient leaves hospital for them to refer to.
A community nursing service is arranged to follow-up and re-fill NIKIs, as well as draw-up further breakthrough subcutaneous medications, but this is generally not until the day following discharge. So, there is a short time period between discharge and the review the following day that the family are responsible for managing any breakthrough symptoms.
The caring@home resources and nurse education has been well-received by most of the nursing staff on the ward. The resources have really met a need in the community for people who choose to be cared for, and die,at home.
The challenge we have met is the lack of hospital policy for ward Registered Nurses (or any of our team) to draw up subcutaneous breakthrough medicines prior to patient discharge, to get them through to the community nursing review on the following day. This is a process that we are working towards.
Access to the caring@home package for carers has assisted our patients to deteriorate or die in the place of their choosing.