C Sheehan1, Ms Mary Lafferty1, M Dunford2, H Green3, A Smith2, F Ritin4
1Departments of Palliative Care, Australia, 2Department of Respiratory and Sleep Medicine, Australia, 3Centre of Research in Nursing and Health St George Hospital, Australia, 4St George Hospital & University of Newcastle, Australia
Biography:
Mary Lafferty is a Palliative care clinical nurse consultant (CNC) at St George Hospital in Sydney Australia. She has worked in a variety of palliative care settings that include the community, palliative care units and acute hospital for the past 31 years. She has post graduate qualifications in palliative care and counselling. Mary has a strong interest in the management of end stage respiratory disease having worked in respiratory specialty prior to working in palliative care.
Abstract:
Background: Inconsistencies in medication dosages used when withdrawing non-invasive ventilatory support (NIVs) led to development of a ‘level of dependency withdrawal of NIVs framework’ to promote consistent symptom management for end-of-life care (EOLC) in respiratory failure. (Figure1)
Aim: Investigate impact of the ‘level of dependency withdrawal of NIVs framework’.
Methods: Retrospective analysis of the impact of the framework was completed between 2015 and 2020 at a large teaching hospital in Sydney Australia. Respiratory symptoms of dyspnoea, anxiety and agitation were collected and analysed.
Results: Data of 81 patients with a mean age of 76.3 years and 51 (63%) were male. Significantly fewer patients had agitation at death following the implementation of the framework (14%) compared to preintervention (42.1%) (OR 0.22, 95% CI 0.08, 0.65). There was a non-statistically significant reduction in dyspnoea and anxiety at death post intervention. After commencement of the framework, 71.6% of all patients were withdrawn from NIVs within 24 hours and 78% by the time of death.
Conclusion: Implementation of this framework has significantly reduced the burden of respiratory symptoms in this patient group during withdrawal of NIVs in EOL.