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Decisions on End of Life care in Dialysis Patients

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Decisions on End of Life care in Dialysis Patients Krishna Appunu and Jyoti Baharani With thanks to all the renal units that completed the survey With thanks to all ... – PowerPoint PPT presentation

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Title: Decisions on End of Life care in Dialysis Patients


1
Decisions on End of Life care in
Dialysis Patients
  • Krishna Appunu and
  • Jyoti Baharani

2
Background
  • The Renal MDT is often faced with making
  • difficult decisions on End of life(EOL) care
  • in dialysis patients
  • Literature on EOL decisions and how and
  • when they are made in dialysis patients is
  • limited

3
National End Of Life care program
  • End of Life care in advanced kidney disease
  • Framework to implement quality end of
  • life care.
  • Recommends the use of various tools-
  • GSF,PPC,LCP

4
Dialysis and CKD patients needing EOL decisions
  • Conservative management patients
  • Dialysis withdrawal
  • Inter current acute illness malignancy
  • Failed transplant patients not starting back on
  • dialysis

5
End of life care in advanced kidney diseaseA
framework for implementation.
6
Aims
  • To understand the decision making
  • process behind End of Life Care choices
  • in dialysis patients

7
Methods
  • Online survey tool- National
  • All dialysis units which offered acute and
  • chronic haemodialysis support
  • Survey questionnaire was sent
  • to 66 renal units in the UK

8
Results
  • Renal directors-36 responses received
  • electronically
  • Telephone follow up Renal Matrons,
  • Specialist Nurses - 24 responses
  • 91 response rate - 60 units

9
  • Nine questions included in survey
  • CPR Policy
  • Advance directives
  • Dialysis teams contribution to EOL decisions
  • Providing information leaflets
  • EOL Pathways

10
Do you have a written resuscitation or DNAR
policy within your unit for dialysis patients?
Yes - 34 No - 26
11
Does this policy apply to Acute Haemodialysis
patients?
Yes - 33 No - 24 Skipped question - 3
12
Does this policy apply to chronic dialysis
patients ?
Yes - 32 No - 21 Skipped question - 7
13
Do you provide information leaflets with regards
to CPR, Advance care planning DNAR for your
patients?
Yes -12 No - 48
14
Do the dialysis team make active decisions
regarding patients resuscitation status as part
of the monthly review/QUALY meetings?
Yes - 19 No - 41
15
Do all the chronic dialysis patients have a
documented CPR or DNAR status within their care
plan?
Yes - 28 No - 32
16
Do your dialysis patients have documented
Advance directives/EOL preferences within their
dialysis care plan?
Yes - 39 No - 20 Skipped - 1
17
  • End of Life pathways
  • Which tools do you use for End of life planning
    in your unit?
  • Liverpool care pathway - LCP
  • Gold standard framework - GSF
  • Supportive care pathway - SCP
  • Preferred priorities of care - PPC

18
Current End Of Life Care pathways
Liverpool care pathway- Developed in 1990
Liverpool Royal Hospital Marie Curie
Hospice-12th Version 2009 Preferred priorities
of care- Person held document that facilitates
individual choices in EOL decisions. Dec
2007 Gold standard framework-2000. Developed by
Dr Keri Thomas for primary care. 2004- Nursing
Homes. 2006- Acute Hospitals Supportive care
pathway-Pan Birmingham Palliative Care Network
2006
19
Liverpool care pathway LCP
Response count - 58 Yes - 55 No - 3
20
Preferred priorities of care
Total responses - 49 Yes - 11 No - 38
21
Supportive care pathway
Total responses - 53 Yes - 28 No - 25
22
Gold standard framework
Response count - 51 Yes - 22 No - 29
23
End of life care pathways
24
YORK DGH
  • Answered yes to all the questions
  • Consultant with special interest in EOL care
  • in dialysis patients
  • Specialist palliative nurse with renal interest

25
Summary
  • Most units had a CPR policy however
    implementation
  • was poor.
  • Very few units provided information leaflets on
    CPR/EOL
  • decision.
  • Renal MDT contributed very little in QUALY
    meetings with
  • regards to CPR/EOL decisions.
  • LCP pathway was the predominantly used EOL tool.
  • A uniform policy should be adopted across all
    units in
  • accordance with the national EOL care
    strategy.

26
  • With thanks to all the renal units that completed
    the survey
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