Conservative Management of COVID-19 Patients—Emergency Palliative Care in Action

Abstract

Context. The COVID-19 pandemic is spreading across the world. Many patients will not be suitable for mechanical ventilation owing to the underlying health conditions, and they will require a conservative approach including palliative care management for their important symptom burden.Objectives. To develop a management plan for patients who are not suitable for mechanical ventilation that is tailored to the stage their COVID-19 disease.Methods. Patients were identified as being stable, unstable, or at the end of life using the early warning parameters for COVID-19. Furthermore, a COVID-19especific assessment tool was developed locally, focusing on key symptoms observed in this population which assess dyspnoea, distress, and discomfort. This tool helped to guide the palliative care management as per patients' disease stage.Results. A management plan for all patients' (stable, unstable, end of life) was created and implemented in acute hospitals. Medication guidelines were based on the limitations in resources and availability of drugs. Staff members who were unfamiliar with palliative care required simple, clear instructions to follow including medications for key symptoms such as dyspnoea, distress, fever, and discomfort. Nursing interventions and family involvement were adapted as per patients' disease stage and infection control requirements. Conclusion.Palliative care during the COVID-19 pandemic needs to adapt to an emergency style of palliative care as patients can deteriorate rapidly and require quick decisions and clear treatment plans. These need to be easily followed up by generalist staff members caring for these patients. Furthermore, palliative care should be at the forefront to help make the best decisions, give care to families, and offer spiritual support.

COVID-19: guidance on palliative care from a European Respiratory Society international task force

“…Moreover, families may be in quarantine or ill themselves. [7] The inability to say goodbye to family before death may increase the risk of complicated grief. [36] When family is allowed to visit, PPE might be needed.…”

“…because it can be experienced as too distressing. [7] Other authors do advise remote contact between patients in palliative care and family. [37] Results: Almost all experts strongly (80.9%) or conditionally (14.7%) recommend that family members/loved ones should be invited and supported to visit the patient dying with COVID-19 in person.…”

“…[5] A case series of 101 hospitalised patients with COVID-19 referred for palliative care showed that most patients died within three days, [6] and the need for "emergency" palliative care in COVID-19 has been suggested. [7] Worries have arisen about limited access to palliative care because of high demands worldwide in the pandemic. [3] Despite a number of guidelines and resources proposed by professional and other bodies, neither evidence-nor consensus-based guidelines about palliative care in COVID-19 are available.…”

Cuidados paliativos no contexto da pandemia de COVID-19: desafios e contribuições

“…Em relação às temáticas, duas categorias sintetizam os principais aspectos abordados nos estudos: "Estratégias para implementação dos cuidados paliativos no enfrentamento da COVID-19" (17)(18)(19)21,23,25,(27)(28)(29)(30)(31)(32)35,36,(38)(39)(40)(41)(42)44) (19; 63,3%) e "Terapêutica paliativista no contexto da pandemia: desafios e contribuições" (16,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)31,33,34,(36)(37)(38)(39)(40)(41)(43)(44)(45) (24; 80%).…”

Producing ‘Top Tips’ for Care Home Staff During the COVID-19 Pandemic in England: Rapid Reviews Inform Evidence-Based Practice but Reveal Major Gaps

“…Much of this knowledge is transferable for people dying with COVID-19 and has been adapted for the pandemic (e.g. Fusi-Schmidhauser et al, 2020). Previous research on end of life care has identified that for a small group of residents dying with or from dementia there is uncertainty about the best ways to manage symptoms, liaise with different people involved in decision making and anticipate resource needs.…”