Authors (including presenting author) :
Leung MS (1), Kwong HP (1), Zhou MS (1), Chan SL (1), Ho G (1), Lai MK (1), Lau KY (1), Leung K (1), Wong N (1), Tang SC (1), Tsui CW (1)
Affiliation :
(1) Adult Intensive Care Unit, Queen Mary Hospital
Introduction :
A life-sustaining therapy is commonly withdrawn if it is considered futile and is no longer beneficial to a patient. In intensive care unit (ICU), withdrawal of life-sustaining therapy often leads to ICU or hospital death in which end-of-life care (EOLC) is required. EOLC can prevent and alleviate patient’s and family’s suffering through early identification of imminent physical, psychological and spiritual needs and provision of holistic care to address related perspectives. Key elements includes provision of symptom management to the patient, facilitation of decision making and optimization of the quality of life in the last journey of the patient. This paper describes a nurse-coordinated end-of-life care bundle in a local ICU.
Objectives :
1. To facilitate patients and families in making critical decisions related to withdrawal of life-sustaining therapies.
2. To minimize suffering and discomfort associated with the withdrawal of life-sustaining therapies in patients planned for EOLC.
3. To enhance optimal EOLC for the imminently dying patients in ICU.
4. To provide guidance to clinical staff and align practice on EOLC.
Methodology :
A retrospective review of the service data of an ICU nurse-coordinated EOLC programme between April 2019 to December 2023 was conducted. Patients who were enrolled in the EOLC bundle were included in the review for analysis.
Result & Outcome :
668 patients succumbed in ICU during the review period. Mean age of the recruited patients was 64.8±15.1 years and 67% were male. Median ICU length of stay had gradually reduced from 4 (range 1, 39.4) days in 2019 to 2 (range 1, 29) days in 2023. Number of terminal extubation ranged from 8 patients per annum in 2019 to 30 patients in 2023, potentially reflecting a change in practice and family perception of futility and holistic care after introduction of advanced care planning and EOLC bundle. There was a modest increase from 24 (2019) to 31 (2023) patients in whom limits were set for vasoactive agents or the agents were withdrawn. Nurse-coordinated EOLC plans were conducted in 493 (74%) patients. Referral to hospital palliative care team was offered in 15 (2.2%) patients. Withholding / withdrawal of vasoactive agents were regarded as a more acceptable option by families than terminal extubation. A nurse-coordinated EOLC provision in ICU had shown a positive impact in communication between healthcare providers and the patients and their families, leading to better decision-making process and minimizing prolongation of suffering in patients.
