There was little National or local guidance available regarding withdrawal of non invasive ventilation (NIV) at the beginning of the pandemic.
General ward staff were caring for patients with a significant symptom burden, usually undertaken by intensive care trained staff.
In response, the Palliative Care Team (PCT) within Hampshire Hospitals Foundation Trust (HHFT) implemented several interventions to improve the journey of NIV withdrawal:
Implementation of guidelines
Provision of educational on symptom control & communication skills.
Production of communication aids
Physical presence of the PCT on the wards
The purpose of this study was to review the standard of care received by patients and the staffs skills and confidence.
Method All patients known to the PCT between January and March 2021 who had NIV withdrawan as a result of COVID-19 were included, total of 10. Data was collected retrospectively and in real time.
70% had documented ceilings of care in the form of a ReSPECT care plan discussed on initiation NIV.
100% were included in decision making surrounding withdrawal.
80% were understanding and accepting of the need for withdrawal.
100% were prescribed end of life PRN medication.
90% given sedative medication prior to withdrawal, slight variation in medication and dose.
80% died within 2 hours of withdrawal.
100% had family with them at death or saw their family prior to withdrawal.
ResultsThe evidence suggests that standardised NIV withdrawal guidelines were needed within HHFT.
The changes resulted in:
increased staff confidence in managing NIV withdrawal.
Increased communication surrounding the limitations of treatment on initiation.
Increased control of symptoms prior to and during withdrawal.
Increase in families being involved and present during discussions, withdrawal and death.
There is always a need for individualised care however, there is also a need for a structured approach that can be used as guidance.
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