Intensive Care Nursing/End of Life Care in ICU
Following discussion with the patient and family, a full multidisciplinary meeting should take place once the decision has been made to provide palliative care to ensure the optimum plan of care is provided. Consider the following:
Communication
- Patient
- Palliative Care team
- Intensive Care consultant
- Parent Unit consultant
- Nursing team
- Relative, Carer, Person Responsible
- Allied Health (Social work, physio)
- Other specialists
Symptom Control
- Anxiety and restlessness
- Pain
- Agitation
- Dyspnoea
Therapy Decisions
Consideration of life maintaining interventions and actual requirements such as invasive monitoring (such as arterial, central lines), ventilation, inotropic medications, hydration, CRRT, IABP, ECMO provides many challenges and ethical viewpoints. Meeting patients best interests, includes consideration of medical, physical, emotional, social and spiritual interests, and all other factors relevant to the patient’s welfare.
Initial Assessment
- Airway- Intubated/ventilated
- NIV
- FiO2
- Dyspnoea
- Inotropes
- Able to swallow
- Conscious/ Unconscious
- Confused
- Pain
- Hydration
- Nutrition
- Nausea
- Agitation
- Vomiting
- Restless
- Communication
- Incontinent -urine/faeces
- Catheterised
- Constipated
- CRRT
- ECMO
Location
Palliative care can be carried out in the Intensive Care but consideration of potential discharge to ward, community palliative care or even home should be considered.
Regular Review of Plan of Care:
- A full multi-disciplinary team reassessment & review of the current plan of care should be triggered when:
- Improved conscious level, functional ability, oral intake, mobility, ability to perform self-care
- Concerns expressed regarding management plan from patient, relative, carer or team member
ICUnurses (discuss • contribs) 12:29, 5 September 2014 (UTC)