Trial to improve care of patients who die in general medical wards

Melbourne doctors have trialled a new plan to improve the care of patients who die in general hospital wards in Australia. Kate Jackson and colleagues from Monash Medical Centre said they had developed the Pathway for Improving the Care of the Dying (PICD) because the majority of Australian deaths occurred in general hospital wards and several studies had indicated “concern” about the treatment of these patients and their families. Twenty patients for whom death was anticipated were placed in the trial and medical, allied health and nursing staff attended information sessions to teach them about patient comfort measures, communication, support for psychosocial, spiritual and cultural issues, writing patient information and care after death. While patient numbers were too small to allow for meaningful statistical analysis, the study found a marked improvement in compliance with all PICD indicators including documentation, medication adjustment and patient information. “Interestingly many of the improvements seen were in facilitating communication,” the study authors wrote in the Internal Medicine Journal. They noted that during debriefing sessions many staff commented on their improved confidence in looking after dying patients and their families, and that the PICD had made their jobs more efficient and more satisfying. The study authors said that their project showed that early career doctors and nurses needed support in caring for dying patients and that the time and energy committed to developing such a pathway must be accompanied by an extensive educational programme and a project officer to maintain momentum. Internal Medicine Journal 2009: 39:695–699.  ...