Introduction Despite this year’s challenges with Covid-19, the data collected by Dudley Group Foundation Team has offered assurance that GSF has continued to be embedded across the hospital with improved identification of patients in the last year of life, enabling an individual plan of care and continued use of data to drive improvements. There has been local variation with the level of Specialist Palliative Care (SPC) support for COVID-19 patients and withdrawal of NIV. Local guidelines vary and these can be compared with the Association for Palliative Medicine guidance developed. This review was carried out to look at practice in Dudley Group NHS Foundation Trust.
Method Retrospective review of 20 randomly selected COVID deaths whereby NIV had been used outside of the ITU setting between November 2020 and February 2021.
Results Over a third of patients were on NIV for 1 day only. A decision to withdraw NIV was made in 65% (13/20) of cases reviewed and the remaining 35% (7/20) died with NIV in place. Good discussions were documented around NIV withdrawal with the patients where they had capacity (7/13) and 100% with family. For those that died with NIV in place there were discussions with family regarding an individual plan of care.
Seventy five percent of cases reviewed had anticipatory medication prescribed, however, none required a syringe driver. None of the cases reviewed were referred to the specialist palliative care team and 100% had a DNACPR in place.
Conclusion The results illustrate that none of the cases resulted in referral to the SPC team, however, there was evidence of good discussions and provision of anticipatory medication via the sub-cutaneous route. This suggests that the GSF has supported the respiratory team in providing individualised, good end of life care without the need for Specialist Palliative care input for all cases of NIV withdrawal.
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