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Are we failing to identify patients nearing the end of life?

  • Comments (1)

A study reported in the news last week suggested that the “core business” of hospitals is caring for people who are nearing the end of their lives.

The research team studied 10,000 people in 25 Scottish hospitals on 31 March, 2010.

In total 3,098 patients – almost 31% – died within 12 months and 9% died during their admission.

The authors said, “Our findings provide a platform to invest more energy in identifying patients on admission to hospital who are likely to die within a year and then to develop appropriate care plans for them.”

 

What do you think?

  • Do hospitals focus on treatment and fail to identify patients nearing the end of life?
  • When is it appropriate to start end-of-life discussions with patients and relatives?
  • Do you have access to a palliative care team in your hospital?
  • Do hospital nurses have appropriate end-of-life training?
  • Comments (1)

Readers' comments (1)

  • Anonymous

    I was surprised as a community nurse when I went back to work in an acute medical ward in a large city hospital.

    We had access to a Medical Early Warning System (MEWS) to help identify patients whose condition was unstable and deteriorating over time. It seemed pretty pragmatic stuff to me. It involved taking physiological observations and clinical observation of the patient's behaviour and condition and scoring each element according to the MEWS scale.

    Unfortunately, some of the staff using the scale had problems. When they didn't want to check a particular observation (blood pressure, for instance), they omitted them and simply added up the score without that part. Others didn't take much trouble to measure pulses and respiration rates properly and some just guessed. Patients were not always checked by a registered nurse who could identify subtle changes in their condition.

    Experienced colleagues will realise that this meant some vulnerable patients were scored as being Low Risk, when they were actually very High Risk. We had at least one case where a patient almost died as a result and was in a state of collapse before the doctor was called. I was horrified, because I was used to being accountable as an individual nurse, but on the ward they just accepted the failure as 'only to be expected'.

    I know that diluted skill mix is a fact of life on most wards, but even some of the qualified nurses seemed unable to assess risk even when helped by the MEWS tool.

    It is hardly surprising that problems arise in identifying patients near the end of life, given the weak clinical skills I saw and the fact that nursing records rarely help track patient's status changes over time. It's more than knowing when to call in specialist palliative care in terminal conditions - it's a central skill for all nurses to pinpoint and respond to changes in patients with any diagnosis.

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