geoscience.net logo
+ Resolve Article
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter

+ Translate
+ Subscribe to Site Feed
GeoScience Most Shared ContentMost Shared Content

Business as usual implementation of advance care directives in a renal dialysis unit


, : Business as usual implementation of advance care directives in a renal dialysis unit. BMJ Supportive & Palliative Care 3(2): 247-247

Advance care directives (ACDs) are designed to empower patients and give them a choice in end of life (EOL) care. According to the NSW Health policy established in 2004, ACDs are to be present in patients' medical records for moments when the patients are unable to make decisions for themselves. In 2009, two incidents highlighted the need to implement ACDs as a standard component of the model of care in our unit. To normalise the establishment of ACDs for patients in our Unit, and to have at least 80% of our renal dialysis patients with up-to-date and easily accessible ACD in place. Project guidance was provided to the Ballina project team via the ACI Haemodialysis Models of Care Program. The project involved staff training, patient education, development of an ACD Form, and process change within the renal unit and the hospital. The process was adaptable, flexible and responsive, and staff developed confidence in addressing this difficult issue with their patients. Furthermore, a system was developed to include ACD alerts on the patient's electronic medical record (eMR), making this information available at all access points throughout the health district. ACDs have been established as a standard component of the model of dialysis care within our Unit. As a result of the project the proportion of our patients with active ACDs rose from <5% to above 85%. There remain some difficulties broaching this topic with some cultural groups.DiscussionACDs have the ability to prevent overuse of medical resources and decrease family burden during EOL care. During education sessions it was found that staff had difficulty approaching their patients on these very sensitive and challenging issues, and required considerable training to empower them to support their patients' during advance care planning (ACP). The successful implementation was due to the patients perceiving it as a normal process that they themselves should drive, in collaboration with their families and with their clinical carers. ACP policies require considerable staff training and support to enable successful implementation.

US$19.90

DOI: 10.1136/bmjspcare-2013-000491.57


Other references

Gretchen Kirchner; Arthur L.K.ch; Ronald J.D.yle, 1984: Energized membrane regulates cell pole formation in bacillus subtilis. FEMS Microbiology Letters 24(2-3): 143-147

O'Brien, P.J., 1981: The mechanism of oxygen activation involved in the prostaglandin synthetase mechanism. Progress in Lipid Research 20: 295-298

D.J.nge, W.J.; Van Den Wijngaard, R.M.; The, F.O.; Ter Beek, M.L.nde; Bennink, R.J.; Tytgat, G.N.J.; Buijs, R.M.; Reitsma, P.H.; Van Deventer, S.J.; Boeckxstaens, G.E., 2003: Postoperative ileus is maintained by intestinal immune infiltrates that activate inhibitory neural pathways in mice. Background & Aims: Postoperative ileus after abdominal surgery largely contributes to patient morbidity and prolongs hospitalization. We aimed to study its pathophysiology in a murine model by determining gastric emptying after manipulation of the...

Esmarch, F., 1926: Decaying Strawberry fruits. A number of cases of fruit rot of unripe strawberries, due to Botrytis cinerea, have been reported during the current season to the Plant Protection Service in Dresden. Affected fruits first show light brown spots which are soft to the touch in co...

Sieradzki, K.; Tomasz, A., 1997: Inhibition of cell wall turnover and autolysis of vancomycin in a highly vancomycin-resistant mutant of Staphylococcus aureus. A highly vancomycin-resistant mutant (MIC = 100 mu-g/ml) of Staphylococcus aureus, mutant VM, which was isolated in the laboratory by a step-pressure procedure, continued to grow and synthesize peptidoglycan in the presence of vancomycin (50 mu-g/...

Warf R.T., 1989: Practical considerations for design and operation of microbial harvesting filtration systems. Abstracts of Papers American Chemical Society 198: MBTD 224

Archbald, L.F.; Mather, E.C.; McClure, J.R., 1974: Fimbrial cysts as a cause of infertility in the mare. Veterinary Medicine, Small Animal Clinician 69(9): 1163-1165

Moll, G.; Geißler, S.; Catar, R.; Ignatowicz, L.; Hoogduijn, M.J.; Strunk, D.; Bieback, K.; Ringdén, O., 2016: Cryopreserved or Fresh Mesenchymal Stromal Cells: Only a Matter of Taste or Key to Unleash the Full Clinical Potential of MSC Therapy?. NlmCategory="UNASSIGNED">Mesenchymal stromal cells (MSCs) harbor great therapeutic potential for numerous diseases. From early clinical trials, success and failure analysis, bench-to-bedside and back-to-bench approaches, there has bee...

Maris, M.; Verhulst, S.; Saldien, V.; Van de Heyning, P.; Wojciechowski, M.; Boudewyns, A., 2016: Drug-induced sedation endoscopy in surgically naive children with Down syndrome and obstructive sleep apnea. To describe the pattern of upper airway (UA) obstruction in surgically naive children with Down syndrome and obstructive sleep apnea (OSA), and to evaluate the outcome of drug-induced sedation endoscopy (DISE)-directed treatment. A prospective stu...

Widen S.G.; Wilson S.H., 1991: Purification and characterization of a beta polymerase promoter binding factor. FASEB Journal 5(4): A817