Background Attempting cardiopulmonary resuscitation (CPR) in the hospice setting can be a divisive issue, with some arguing it should not be attempted. Within St Michael’s Hospice, we are managing an increasing number of patients earlier in their illness, when CPR may remain appropriate. Following a patient case, we reviewed our CPR service to ensure it was still meeting the needs of our patients.
Method Following the successful resuscitation of a 42-year-old patient with locally advanced pancreatic cancer after an in hospice cardiac arrest, using basic life support with automatic external defibrillation (AED), the case was brought to the monthly Significant Event Meeting (SEM). This proved a controversial case, although overall we agreed CPR was appropriate for this patient.
Results In response to the SEM, several changes were made. As part of this, a multi-professional educational update was delivered to all staff utilising the resuscitation council ‘lifesaver’ app. As there are no hospice specific resuscitation guidelines, our was updated in line with adapted guidance for primary care and community hospitals, to incorporate the skills of rotational doctors with advanced life support certification. An emergency trolley was introduced to centralise equipment, with an added laryngeal mask airway and a pre-connected bag and mask, and a second AED was purchased to provide quick access for the whole hospice.
Conclusions There are no specific best practice guidelines for managing cardiac arrest in the hospice setting. Following a clinical incident, we have adapted the resuscitation council guidance to develop a local policy. In the future, as we care for more patients earlier in their illness, this contentious issue is likely to present more frequently. Developing a local policy could help ensure high quality resuscitation care within the hospice in response to the changing needs of palliative care patients in the future.
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