In these times of a pandemic, there is a greater need to have sensitive and often difficult conversations. The unique circumstances have also led us to have more phone consultations, which are particularly challenging when the discussion is delicate, as the connection with body language is lost. Wearing PPE adds another challenge with communication.
Below are a series of links, some of which have been developed for COVID-19 and older references that remain relevant. Some are short videos, some links to helpful websites, others have guidance through diagrams, whilst there are longer papers to review if you have the time.
Click here for useful resouces
Having advance care planning conversations with our patients is always important, but the current COVID-19 pandemic has shone a spotlight on the unwanted consequences of not undertaking this planning. This applies to people dying from both COVID and non-COVID related conditions. If we do not ask our patients about their wishes and what really matters to them, then we risk missing the opportunity to help them achieve a good death.
However, it should be recognised that these can be challenging conversations, which can create anxiety in the initiator, and need to be thought out and planned to enable them to be undertaken with compassion and sensitivity.
NICE Covid-19 rapid guidelines offer a useful decision aid algorithim for the most appropriate carefollowing admission to hospital. But what about those difficult decisions we have to make in the community prior to that?
It is important to remember that most people with Covid-19 will survive and recover. But those who are older with co-morbidities are less likely to do so, which underlines the importance of recognising frailty and those who are dying.
National guidance regarding symptom control in COVID-19 has been reviewed by the CCG Medicines Optimisation Team and clinicians from the four Devon hospices.
After collaboration, the following pan-Devon guidelines have been drawn up. The first is a link to the COVID-19 symptom control packs. These are a list of oral medications and injectable medications that may be needed for patients at home and in a care home. These will be used for patients who, for whatever reason, are not being admitted to hospital. This may be because they have mild symptoms and do not require hospitalisation or because the (advanced) decision, is that their ceiling of care will be home/care home.
The aim of this guidance is to provide a framework for the timely verification of expected adult deaths by experienced(i.e. assessed as competent) health care professionals. It will enable staff to care appropriately for the deceased, inline with local policy, and minimised stress for families and carers following an expected death at any time. It is inline with the person and family centred care recommended in national documents.
With the current crisis meaning that sadly, more people are dying – and often more quickly – St Luke’s are extending the reach of their bereavement support service to anyone who has lost a loved one to COVID-19 or is anticipating this heartbreak. People can self refer and do not have to linked to St Luke’s care services.
We also know that COVID-19 has made loss even more complex for so many people. They might not have been able to visit their loved one in a care home or hospital, or perhaps they’ve had to make extraordinarily tough decisions on who could attend the funeral.
If they need help, just ask them to pick up the phone and call our team on 01752 964200. Whatever they are feeling, we will listen and support them.
We’re also here for health and social care teams, recognising the toll the pandemic is taking on those working in hospitals and care homes. We’ll give you the space and support you need to reflect, de-brief, release some emotion and signpost you to the most appropriate support.