Winter ESIM – Inquiry – Jan2020

Winter ESIM

In our Winter School, this year, we will discuss end of life decisions. We want to have residents participation and intervention. So I am asking you to answer the following inquire related to imminent death (“last hours / days of life”). The questions have been selected from "Consensus on good practices in the intervention with patients hospitalized in Internal Medicine in a situation of last days of life", organized by SPMI (Portuguese Society of Internal Medicine) and SEMI (Spanish Society of Internal Medicine), in 2019, following the Delphi methodology. The objective was to high light basic needs in imminent death situations. Based on such a survey, Internal Medicine services, have an opportunity to review and hopefully improve their resources and methodology in those situations.

In this survey, we have selected 25 of the questions of that consensus to survey residents perception of the conditions that they have in their own services.

Deadline to response: January 15

Before starting, please let me know your:

Gender *
Country where you work as resident: *
1. In your service, upon admission, palliative needs of the patient are assessed, and the assessment is repeated during hospitalization? *
2. In your service, upon admission, patients in last days of life are identified and that assessment is repeated during hospitalization? *
3. In your service the condition of sick person needing palliative care or in a situation of imminent death (last days / hours of life) is explicitly written in clinical records? *
4. In your service do you explore, with hospitalized patients with advanced disease, what he knows about his illness and his values and preferences *
5. In your service it is explored what family members of hospitalized patients with advanced disease, know about the disease and their values and preferences are exploited *
6. In your service leaving wills and advance directives documents of hospitalized patients with advanced disease are consulted? *
7. In your service leaving wills and advance directives documents of hospitalized patients in imminent death (last days / hours of life) are consulted? *
8. In your service is it documented in clinical records of the hospitalized patient with advanced disease what he and his family members know about the disease, what are values, preferences and wishes of the patient, as well as the early policies of will, when they exist. *
9. In your service, in the presence of a patient in a situation of last days / hours of life, family and caregivers are informed of the proximity of death. *
10. In your service, the process of providing information to the patient and family members is documented in the clinical records? *
11. In your service, patient and family information takes place with intimacy and privacy? *
12. In your service, there is a written protocol, which includes appropriate time for communication with the patient and family. *
13. In your service, the condition of the patients in last days / hours of life, the presence of symptoms and the degree of their control is, systematically, evaluated and documented in clinical records. *
14. In your service there are up-to-date clinical guidelines for palliative care in last days / hours of life, oriented towards comfort and symptom control *
15. In your service the therapeutic plan adjusted to the actual condition of the patient", is shared with patient and/or his family, by the care team and made consensual. *
16. In your service the therapeutic plan adjusted to the current condition of the patient", is documented and justified in clinical records. *
17. In your service, in presence of a patient in last days / hours of life, scans and diagnostic procedures that compromise comfort to the patient are avoided? *
18. In your service, when in presence of patient in imminent death (last days / hours of life) it is considered the indication to establish DNR (Do Not Resuscitate Order) and that is clearly documented in clinical records? *
19. In your service, when in presence of patient in imminent death (last days / hours of life) spiritual needs of the patient and the family are evaluated? *
20. In your service, the patient in condition of imminent death (last days / hours of life) is accompanied in a single room *
21. In your service, the patient in condition of imminent death (last days / hours of life) the company of family members is facilitated *
22. In your service, the patient in a condition of imminent death (last days / hours of life) has a specific prescription care plan *
23. In your service, the ward care plan includes skin, oral, feeding, intestinal and bladder elimination, respiratory pattern, rest and pain control and other symptoms of terminal disease. *
24. In your service, in the shift rounds (stopovers, shift change, weekends, holidays, ...) a structured communication about the patient in last days / hours of life is made *
25. In your service, family members of the patient in condition of last days / hours of life have facilitates access to religious and psychological support. *

Thank you for the collaboration/preparation for the debate on "end-of-life decisions"