NICE urges doctors to treat dying patients as individuals

My father, who was a retired doctor was admitted to Ealing hospital as emergency. Same hospital where I had whistle blew on fraud. Previously I and my mother cared for him at home instead of placing him in a care home. Being a whistleblower and having covered many incidents involving care homes we did not feel this was a safe option. Additionally, we wanted to be with him and tend to his needs and comfort. There is nothing like being at home with your family and we loved him. I felt privileged to be there and look after him.

When emergency rose, where father had lost momentary consciousness, mother called the emergency services.  Ambulance had  no option but to take him to Ealing Hospital, as A&E based at Central Middlesex had been closed down – which is really unfortunate as both myself and my family have used the services there previously and found it  to be  excellent. My father too had been previously been a patient there and he was treated with great respect and dignity by staff at all levels.

Having worked at Ealing where I had reported fraud, it did not fill my mother or I with any confidence of placing my father there.

When my father was admitted at Ealing A&E I asked if he could be transferred to Central Middlesex but the request of refused. His condition had improved but he was admitted. However his care whilst in hospital was far from satisfactory and  he passed away with 2 weeks of being admitted. He was starved, dehydrated and not given his insulin which was essential for his long standing diabetes for 10 days. I suspect his other medication were also likely to have been excluded.

I discovered another patient’s notes in his file.

Father’s condition deteriorated before our eyes where he was being administered oxygen.

His last meal that I fed him was mashed banana and toffee yogurt- his favourite.

The evening before he died the team transferred him to a side ward as the consultant later advised that he knew my father did not have long. However, he omitted to advise this to us as the family at the time. So, we were not given the opportunity to see him before he passed away early the next morning.

I wrote to the CEO at Ealing hospital:

https://sharmilachowdhury.com/letter-to-ceo-at-ealing-hopsital/

The response from the CEO was far from satisfactory. There was no promise of any investigation for future prevention. Instead the CEO blamed the situation on A&E not documenting his medication – which was false, as pharmacy had called me, day after his admission, to confirm the amount of insulin. The CEO also attributed the failures to lack of consultants during the weekend. Again, not really a good reason as starvation, dehydration and omission of medication had occurred during the week. As had the presence of another person’s notes in his.

Not only had I suffered at Ealing after raising concerns of fraud , we had to further witness the appalling treatment of my father by the same hospital.

The treatment of the elderly and the vulnerable has a long way to go. The following guidance from NICE is a welcomed step forward. The question now remains is how will this be implemented? Who  will be supervising this to ensure adherence? In cases of failures how will individuals be held to account?

BBC News 16  December 2015
Media caption The new guideline emphasise communication, as Adam Brimelow reports

 

End-of-life care in England must be tailored to the needs of dying patients rather than a “tick-box approach”, the health watchdog NICE says.

Patients must be treated with respect and compassion, it said, and doctors should avoid making “snap decisions” about whether someone was dying.

The guidance is designed to address misuse of the previous system, the Liverpool Care Pathway.

Charities welcomed the new guidelines – but warned more investment was needed.

The Liverpool Care Pathway (LCP) was introduced in the late 1990s, in an attempt to ensure people had a dignified and comfortable death.

Among other things, it involved checklists prompting staff to consider whether invasive procedures, drips and drugs should be withdrawn from people in the last stages of life.

But it was phased out last year after a government-commissioned review revealed serious concerns that it was being used in the wrong way, leading to a “tick-box” culture.

Reports suggested that incorrect use of the LCP left some patients without food and water.

‘Individualised approach’

The new wide-ranging guidelines – the first national guidelines to be introduced in England – cover many of the same key principles as the LCP.

However, NICE called for a stronger focus on individual plans for each patient, saying their wishes and those of their family must be central.


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Prof Sam Ahmedzai said this needed to be underpinned by a change in attitude to ensure staff had more respect for care of the dying.

“You have to look at each individual person and respect them as an individual person, ask them about their wishes,” he told BBC Radio 4’s Today programme.

“Some people may want interventions, may want tests to carry on. Others may want to stop all those things. Some people may want fluids, others may not want fluids. So respecting the individual and not having a one-size-fits-all approach.”

The expert panel acknowledged that recognising whether someone is in the last few days of life can be difficult.

Staff should seek guidance from senior colleagues if there were uncertainties and avoid snap decisions, the panel said.

The guidelines emphasise that patients must be monitored for improvements on a daily basis. Staff are offered information on how to spot signs that death is imminent.

Hydration

The document also looked closely at hydration for people in their last few days of life.

Previous reports suggested that when the LCP was used incorrectly some patients were left so thirsty they tried to suck water from sponges used to moisten their mouths.

The new guidance says anyone who is capable of drinking should be encouraged to do so if it is safe and family and friends should be able to help.

But despite these recommendations, experts say there is a lack of evidence about whether giving or withholding fluids can prolong or shorten life in these circumstances.

Lord Howard, chairman of Hospice UK, welcomed the guidelines but said there would be real challenges putting them into practice.

“There can never be ‘a tick-list approach’ towards caring for the dying and this guidance must be underpinned by greater investment in training and education for all staff involved in end-of-life care.

“This is crucial if we are to avoid the failings of how the Liverpool Care Pathway was implemented,” he added.

 

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