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COVID-19 (Coronavirus info)

Information and guidance for public, NHSGGC staff, and community-based services.  Hospital visiting restrictions now in place.

End of life care

Caring for residents who may or may not have COVID-19

It is likely that as a care home worker you will care for someone with suspected or confirmed COVID-19 during this current pandemic. It is important to remember that older and frail people can and do recover from COVID-19. The majority do improve and recover in time with your ongoing care and support, however you may also need to provide end of life care.

Be confident in what you can and already do very well to support people who are at end of life.  You can continue to...

Be confident in what you can and already do very well to support people who are at end of life. 

You can continue to care for people with COVID or with suspected COVID really well, the same way you’ve looked after people who have died in the care home already over the years with caring and compassionate nursing care and personal care and symptom control.

 

Everyone is entitled to have access to end of life care and NHS Scotland published their guideline Caring for people in the last days and hours of life at the end of 2013. It advises professionals to follow four key principles of care.

1. Informative, timely and sensitive communication is an essential component of each individual person's care.

2. Significant decisions about a person's care, including diagnosing dying, are made on the basis of multi-disciplinary discussion.

3. Each individual person's physical, psychological, social and spiritual needs are recognised and addressed as far as is possible.

4. Consideration is given to the wellbeing of relatives or carers attending the person. 

These principles should be followed in any setting for end of life care and you will be aware of these and already following these principles during this pandemic, however there are safety measures that need to be in place and new guidelines introduced for symptom management at the end of life. As you will be well aware we now wear PPE to protect both our patients and ourselves at this time. The following guidelines are specific for symptom management during covid 19.

End of Life Care Guidance when a Person is Imminently Dying from COVID-19 Lung Disease

The nursing and personal care of patients at the end of life is important and The Helix Centre has developed a two page factsheet (pdf) covering practical care for when someone is dying. This can useful to go over and share with families also.

If you are feeling worried about caring for someone who is dying you might find this short film clip from palliative care doctor and author Dr Kathryn Mannix helpful.

Hydration at the end of life

Mouthcare at the end of life

Communicating with health care professionals about a resident's health

Decisions regarding admission to hospital need to be based on the individual wishes and needs and previous and curren...

Decisions regarding admission to hospital need to be based on the individual wishes and needs and previous and current health of of that person and the symptoms they have at the time.

Many residents will already have an anticipatory care plan (ACP) in place. This ACP would hopefully have recorded previous discussions about what is important to that person if they were to become seriously unwell. If that person then does become unwell, the GP, ANP, district nurse and care home teams can look at the individual’s case with them and their loved ones and make a decision on whether admission to hospital would benefit the patient. Further information on anticipatory care planning is available.

When someone is transferred to hospital they will likely be transferred by ambulance to a specific medical receiving ward and will be assessed there initially. They will then have investigations such as blood tests, X-rays and will wait for further review there.

In hospital, once it is recognised that someone is dying, there’s not much from a clinical perspective that can be done other than providing personal care and support. 

For frail elderly patients and patients with dementia finding themselves in this situation in hospital can be really difficult as they are in an unfamiliar environment with clinical staff they don’t know and who do not know them and their likes and dislikes. Often with COVID the supportive care provided in hospital in this situation may not be different from the end of life care provided by you in the care home.

 

 

 

 

 

You and other care home staff will know the person really well, and if you feel that you don’t understand why a decis...

You and other care home staff will know the person really well, and if you feel that you don’t understand why a decision has been made either to admit or not admit the person then please raise this with the Advanced Nurse Practitioner (ANP), GP or district nurse. They will be able to listen to your concerns and explain the reasons for the decision taken.

Remember that if the person is nearing end of life it may not be in their best interests to move them to the hospital and the care they receive with you will be provided in their own home by carers and nurses who know them best.

Medicines can be provided to manage symptoms at end of life and additional palliative care specialist support is at hand to help advice and guide you in your practice.

Your Advanced Nurse Practitioner (ANP), Care Home Liaison Nurse (CHLN), GP, NHS24 and GP Out Of Hours Service, Distri...

Your Advanced Nurse Practitioner (ANP), Care Home Liaison Nurse (CHLN), GP, NHS24 and GP Out Of Hours Service, District Nurses, and Palliative Care team are all here to help. Hospices can also provide palliative care advice: 

- Accord Hospice 01415812000

- Ardgowan Hospice 01475 726 830

- Marie Curie Hospice – 0141 557 7400

- Prince and Princess of Wales Hospice 0141 429 5599

- St Margaret’s Hospice 0141 952 1141

- St Vincent’s 01505 705635

The Fast Track Service with Marie Curie can also provide support for care homes in Glasgow:

Phone: 0141 557 7511 - option 2

9am – 5pm, Monday to Friday

Hospital Geriatricians are also available and through palliative care or GP they can be contacted and will answer your questions. Contact info 

The Just in Case Medications Box is a small supply of every day medicines for straight-forward symptoms like pain or temperatures. These are there for you to use ‘just in case’, after conversation with GP, District Nurse or ANP. The idea of the box is to cut down on time from prescription to pharmacy and delivery. So if the person is very unwell their symptoms can be managed quickly. 

There aren’t controlled drugs, such as those to calm people down or reduce agitation or very strong painkillers, and these can still be prescribed through the usual routes. 

If the patient was approaching the end of life then you would need to ask the GP or ANP for any controlled drugs you might need to manage breathlessness, agitation or pain. These are prescribed for the specific patient.

To assist with managing breathlessness, oxygen concentrators are now in all care homes in NHS GGC who wanted them. To start the oxygen please discuss with the patients GP or ANP. The Community Respiratory Rehabiltiation Teams are available to offer advice and support:

- QEUH/GGH/VIC Team

o Kirsty Murray -Lead Respiratory CNS

o Contact No: 0141 451 6073/6074

o Mon-Fri 8-6 Sat Sun 8-4

- Clyde -RAH/IRH/VOL Team

o Suzanne Adams -Lead Respiratory CNS

o Contact No: 0141 314 7400 (RAH) 0147 550 5047 (IRH)

o Mon-Sun 8-4

- GRI/Stobhill Team

o Joan Brand- Lead Respiratory CNS

o Contact No: 0141 211 4402

o Mon-Sun 8-6

These are new times for us all and we’re all working together. 

Know that the treatment they would access in hospital is now available in care home settings so please feel confident in the care you provide.

JIC medications and oxygen - in depth

JIC medications - summary

ANP/CHLN/GP Support

Formal confirmation of death is a process that may be undertaken by suitably trained and competent registered healthc...

Formal confirmation of death is a process that may be undertaken by suitably trained and competent registered healthcare professionals. This can contribute to the provision of safe, effective and person-centred care at the end of life. In residential homes at the moment Verification of Death forms are provided by the GP. However now in nursing homes the availability of Confirmation of Death paperwork may help staff to manage death and minimise clinician contacts. The use of this form by care home nurses will avoid any delay in confirming death that will reduce unnecessary distress for those who are bereaved, and to other residents or staff. Funeral Directors cannot remove the deceased person until formal confirmation is completed.

Certification of Death remains the responsibility of the patient's registered GP.

NES provide learning resources related to undertaking confirmation of death.  

Confirmation of Death Resources Web Page 

Confirmation of Death Guidance, Policy, SOP, forms and education. Community Learnpro and Moodle link to CoD module allowing free access for all. Updated documents expected soon along with confirmation of how the policy will be implemented in NHSGGC.

Bereavement and COVID-19 Resources

More bereavement information and support is available on our Covid-19 site.

Collection of resources relating to Bereavement and Covid-19 with information on local services.

 

Last Updated: 25 November 2020