Authors (including presenting author) :
Chuk C Y (1), Chau Y K (1), Lam H Y (1), Chan K F (1), Chun N Y (1), Ho Y S (1), Chu L S (2), Lui K Y (3), Kwan W M C (1) (2) (3)
Affiliation :
(1) Home Care, Bradbury Hospice, (2) Hospice Center, North District Hospital (3) Palliative Care Unit, Alice Ho Miu Ling Nethersole Hospital
Introduction :
Poor oral intake is a very common reason for hospital admission in the last few weeks of life. Thus, palliative patients may undergo excessive investigations and treatments when they are rushed to the Emergency Department (AED). Additionally, limited visiting hours hinder family gatherings during hospitalization. As a result, the demand on 'Die at home’ was increasing after COVID19 outbreak to minimize avoidable suffering associated with hospital admissions. In response to patients' Advance Care Plans (ACP) expressing a desire to remain in their preferred place of care, the 'AQUA' Home Care Nursing Program was developed. The program name 'AQUA' represents the following components: A for ACP of patients, Q for Quality care provision, U for Union with family, and A for Active support for patients and their relatives. The AQUA program aims to fulfill patients' wishes to remain in their preferred place of care during their final weeks of life while reducing suffering caused by unnecessary admissions to AED.
Objectives :
The objectives of the program were, 1) Reduce hospital admissions by fulfilling patients' Advance Care Plans (ACP) to allow them to remain in their preferred place of care for as long as possible during the terminal phase, thereby minimizing hospital bed days. 2) Support Subcutaneous (SC) fluid infusion at home / in residential care homes (RCHE) to maintain hydration.
Methodology :
The program ran from 1st July, 2023, to 31st March 2024. We engaged three palliative home care centers in NTEC (BBH Home Care, NDH Hospice Center, and AHNH Palliative Unit, to implement the program. Patients were recruited when they expressed their ACP to remain at home or in a residential home for as long as possible with manageable symptoms. Caregivers were competent to look after the patients. Palliative home care nurses conducted at least 2 times home visits per week and provided subcutaneous (SC) fluid infusions for those dehydrated patients. Besides, symptoms monitoring, emotional support, caregiver training, and relevant information were offered. Doctors home visit as necessary. Patient data was collected for analysis, and a caregiver satisfaction survey was performed.
Result & Outcome :
A total of 34 home care patients were recruited, of whom 9 received SC fluid infusion at home. Among these patients, 23 (68%) home dwelling patients and 11(32%) RCHE patients. Three patients successfully fulfilled their wish to die at home, and 15 (44%) avoided AED admission. There were 25 (73%) admitted to hospital, with 20 (59%) staying only 0 to 3 days at last hospital admission. This figure suggested that patients had stayed as long as possible at home. In addition, 330 hospital bed days were saved during the AQUA program period. Furthermore, the caregivers survey showed 100% satisfy the service. The program service is successfully achieved patient-centered care and promoted the essence of palliative care.
