Göttinger Palliativkrisenbogen: Verbesserung der notfallmedizinischen Versorgung von ambulanten Palliativpatienten

Abstract

Currently more and more patients with cancer will be treated at home, especially at the final stage of their disease. Relatives and nursing services will therefore be confronted with acute emergency situations concerning these patients. The handling of these acute situations may be beyond the relatives' coping capacity. For that reason the pre-hospital emergency system (2.5% of all emergency calls) will be confronted with very specific needs of these patients. Emergency situations of palliative patients at home are more predictable than other circumstances. It is thus possible to achieve a practicable preparation for such emergency situations. An individual "emergency plan" should be created for these cases.. The plan may be processed in an emergency situation. It may then be possible to avoid emergency calls and make it possible for the patient to remain at home. This promotes the patient's quality of life and his/her predominant desire to stay at home after the emergency. An advance directive should be made which records the patient's wishes. Because of the complexity of an advance directive it is essential to indicated the patient's wishes in a short and quickly read form in case an emergency arises. This is one of the reasons for producing a short version like the "Göttingen palliative emergency card". In acute situations it is then possible quickly to make known the patient's wishes The patient may be given the possibility of remaining at home after an emergency situation has been dealt with successfully.

Prehospital emergency treatment of palliative care patients with cardiac arrest: a retrolective investigation

“…In Germany, so-called palliative crisis cards are often used to show the patients will not to be resuscitated [18]. In the present study, nine patients were resuscitated even though an advance directive was given to the emergency medical team by the care-giving relatives.…”

A complex regional intervention to implement advance care planning in one town's nursing homes: Protocol of a controlled inter-regional study

“…In addition, medical professionals like nurses, emergency teams or physicians have not yet defined how to consider ADs appropriately in their decision making process. With few exceptions limited to hospice or critical care settings [10], physician orders for life-sustaining treatment (POLST, [11]) have not yet been implemented into routine care. Thus, notwithstanding recent legal endorsement of ADs in Germany there are no regional structures in place suggesting that effective ACP can be initiated, completed, or followed.…”

Vorbeugendes Krisenmanagement in der allgemeinen ambulanten Palliativversorgung

“…In der spezialisierten ambulanten Palliativversorgung (SAPV) ist es zunehmend üblich, Palliativpatienten einen Notfallbogen bzw. einen Notfall-Behandlungsplan auszustellen [7,19,26]. In der allgemeinen ambulanten Palliativversorgung (AAPV) werden diese Instrumente nur selten eingesetzt [8].…”

“…In der allgemeinen ambulanten Palliativversorgung (AAPV) werden diese Instrumente nur selten eingesetzt [8]. Der Notfallbogen enthält Absprachen zu Therapiewünschen und Therapiebeschränkungen [26,27]. Er stellt eine Patientenverfügung mit der Reduktion auf wesentliche Therapieabsprachen dar [14,18,27].…”

“…Der Notfallbogen stellte eine Modifikation eines bereits 2008 publizierten Bogens dar [26]. Der Fragebogen wurde für die Querschnittstudie zur eigenständigen Bearbeitung entworfen und nach einer Testphase (fünf Bögen) eingesetzt ("self administered mailed survey", 21 Items).…”