Interdisciplinary Team
For support and education about feeding and nutritional needs, refer to this health care provider
Dietician
Or
SLP
Ideally, this device is deactivated to prevent the patient getting unnecessary “shocks”
ICD (implantable cardioverter defibrillator)
When a patient can no longer swallow oral meds, this is the preferred route
Subcutaneous
This length of estimated prognosis, is what triggers the appropriate use of the EOL order set
Days to hours
This is believed to be the last sense to go
Hearing
When a patient is expressing distress about the meaning of their life, consultation with this health care provider is indicated
Spiritual care
This non-pharmacological intervention is one of the most effective ways to alleviate terminal secretions
Recovery Position
Opioids not only treat pain, but can do double duty to treat this symptom
Dyspnea
This team member can advocate for the End of Life order set to be initiated
Any team member
This therapy is not needed if the patient is not complaining of dyspnea, in fact, it may cause more discomfort
Oxygen
A referral is indicated for this health care provider when existential questions are of concern to our patient or family
Spiritual Care
Or
SW
Reassure family members that these tests are unlikely to give us information that would guide or influence care and need to be discontinued
Lab investigations
This medication can do double duty, being indicated for both nausea and as a first line to treat agitation
Haloperidol
This is where you will find the order set electronically
MediRex
"Food is no longer nourishing and in fact may cause discomfort” is the appropriate teaching to which family fear
Starvation
If the family members wishes do not align with patients priors expressed wishes, consultation with this health care provider is indicated
Ethics or SW
These numbers do not prognosticate and will fluctuate. Therefore, reassure the patient/family that the focus is comfort and we will not be monitoring this . . .
Vital signs
After first line Haloperidol and second line Methotrimeprazine, this medication is used for terminal delirium, agitation and seizures
Midazolam/Versed
This is one of the criteria for EOL order set initiation.
NO CPR;
Comfort measures only
3 symptoms that are possible indicators of approaching death include . . .
Decreased urine output, awareness, insight and perception
Increased irregular heart rate
Increase sleepiness
Decrease eating and drinking
Slightly open eyes
Oral and ocular dryness
Shallow breathing
Changes in skin
Restlessness and agitation
incontinence
These support systems are in place for health care providers who wish to debrief difficult cases
Employee Assistance Program;
Employee Health, Safety & Wellness;
Ethics
Peer Support and Debriefing
When IV hydration could cause more harm than good, but the family insists on hydration, this offers a gentler compromise
Hypodermoclysis
This medication to treat terminal secretions is the better choice if the patient is still awake as it does not cross the blood/brain barrier and has fewer side effects.
Glycopyrrolate
The End of Life order set is initiated when patients have been diagnosed with a terminal illness and goals are this only
Comfort
It’s important to teach family members that although it seems counterintuitive, monitoring this vital sign in particular, does not tell us whether our patient is short of breath
Pulse oximetry
O2 sat