End of life care gone wrong

[rachelgeorgina]

I'm not actually a nurse (yet) and this is really from a relatives point of view, but I wanted to share it here.

Patient is an 87-year-old female with COPD/Type II Respiratory Failure, end stage. She was discharged from the respiratory ward three days ago into the care of her family with the parting words, "she's dying, we don't know whether it will be days or weeks" and no offer of support, sympathy or palliative care services from the medical staff. Three days later patient is found, at home, with a GCS of 6, laboured breathing (more so than typical) and a raspy, wet gurgle. Community nurse arrives in the home and assess the patient - who is very obviously in severe CO2 overload and, bluntly, dying. Not dying as in the broad sense of the word, a process - but dying now, today, soon. Nurse assesses the patient and then sits down with the family and recommends.... get this: finding a GP who will do home visits.

Does anyone else see something wrong with this situation?

The patient is actually my grandma. When the nurse left without doing anything other than assessing that signs of life were draining, and draining quickly, it was suggested (by someone else) we phone an ambulance. The paramedics couldn't have come sooner.

[traumaRUs, MSN, APRN]

I am so sorry you are going thru this. I'm gathering from your verbage, you are in the UK?

Do you have hospice available? This is the type of care that should have been offered to your grandmother....they help care for pts who are dying and ensure that the pt and family is comfortable.

[rachelgeorgina]

I am so sorry you are going thru this. I'm gathering from your verbage, you are in the UK?

Do you have hospice available? This is the type of care that should have been offered to your grandmother....they help care for pts who are dying and ensure that the pt and family is comfortable.

Thank you for your kind words. We're in Australia and hospice certainly is available, however there's formalities and waiting lists and at the moment it doesn't look like we have that sort of time.

[tewdles, RN]

I am sorry for the inadequate care that your grandmother received at the end of her life. I wish that the scenario you described was uncommon, but I am afraid that similar experiences are too common here in the USA.

Clearly you are aware, that palliation of symptoms and hospice support would have been most appropriate for your grandmother, it is unfortunate that none was available to her. I too am a bit frustrated by the lack of action by the visiting nurse, but frankly, if she was not working for hospice her hands were tied...she would have had no orders to accomplish the support she apparently recognized that your family needed.

Call your grandmothers doctor. Get orders for medications to palliate her symptoms. Your family can give them. She needs morphine or other opioid for work of breathing, she needs medication for anxiety and nausea. Good luck, and I am sorry about your grandmother.

[traumaRUs, MSN, APRN]

I am so sorry!

[ghillbert, MSN, NP]

Really there is too little education among healthcare providers across the board about palliative care services, and when to get them involved, and in whom. I work with heart failure patients, most of them end-stage, and we have a great palliative care psychiatrist who sees them and it's just incredibly valuable.

If more nurses were aware of when and how to refer, perhaps someone could have advocated for this woman before discharge.

I do feel you were somewhat disingenuous with your first post seeking input; you should have mentioned you were a family member and not healthcare provider in the scenario described.

Sorry about your grandma... I am going through similar crap time with my mum and it's awful.

[PostOpPrincess, BSN, RN]

Waiting lists?

Universal healthcare?

I'm so sorry.

[OncallRN]

I'm so sorry, I pray you can get her into a hospice/ palitive care program. or at least a doctor who will get her the comform medication

[RNKPCE]

Thank you for your kind words. We're in Australia and hospice certainly is available, however there's formalities and waiting lists and at the moment it doesn't look like we have that sort of time.

Waiting list for hospice???? That is really a shame. I am sorry you don't/didin't have the support you, your family and grandma deserved.

[leslie :-D]

Call your grandmothers doctor. Get orders for medications to palliate her symptoms. Your family can give them. She needs morphine or other opioid for work of breathing, she needs medication for anxiety and nausea. Good luck, and I am sorry about your grandmother.

i very much agree, about getting these suggested orders, as well as something for secretions as well.

i would really encourage you being aggressive about this.

did you go through all those hospices that i linked for you? (from your other thread)

leslie

[Not_A_Hat_Person, RN]

If there's a waiting list for hospice, a GP who does home visits might be the next best thing. They can give orders for morphine, scopalamine, and other medications.

[thehipcrip]

I do feel you were somewhat disingenuous with your first post seeking input; you should have mentioned you were a family member and not healthcare provider in the scenario described.

Just curious as to how and why that would change the advice you offered to her. Would you have omitted information had you known she was a layperson?