Planning for an Expected Death at Home An Initiative of The South East Palliative & End-of-Life Care Network Service Delivery Committee.

Planning for anExpected Death at Home

An Initiative of The South East Palliative & End-of-Life Care Network Service Delivery Committee.

Palliative Care

• Care for those living with

life-limiting, life-threatening illness

• Advance care planning is recommended as soon as you are able to introduce the topic to patient & family

PresentationPresentationPresentationPresentation DeathDeathDeathDeath

Hospice Palliative Care

Model for Palliative CareModel for Palliative CareFrank Ferris Oct 2005

Therapies to modify disease

End-of-lifeCare

Therapies to relieve suffering and/or improve

quality of life

BereavementCare

Planning for a Home Death

• Who pronounces death?• Who is responsible for certification of death?• Who does the family contact at time of death?• What about the DNRC form?• How do we help families prepare for death?• Who makes sure everything gets done?

South East Local Health Integration Network Map

We Need a Plan!

Working group established under the direction of the Palliative & End of Life Care Network

Reported to the Service Delivery Committee of the Network

Consultation with nurses, case managers, physicians, EMS, funeral directors

Do not resuscitate

• A plan of treatment is developed that reflects the expressed wish of the patient (or consent of the substitute decision maker for the person who is not capable) that CPR is not in the patient’s plan of treatment.

• DNRC form is completed providing direction for EMS practitioners

The Yellow Folder

Yellow Folder Contents

• DNRC Form• Yellow Magnet• Algorithm• Guidelines• Brochure When Death Occurs at Home• A checklist for Case Managers in folders at CCAC

What do you do with the magnet?

• The magnet is a signal that the yellow folder is in the home

• May be very helpful for EMS on a 911 call

• It is meant to be placed on the refrigerator door

The Algorithm• A tool to assist with planning for pronouncement

and certification of death

• Nurses (RN or RPN) can pronounce death

• Only a physician or RN(EC) can sign a death certificate

MDor

RN (EC)or

Medical Group Will not attendhome to pronounce

ornot available 24/7

Will attendhome to pronounce

and certify24/7

Nurse pronounces

MD or RN (EC)or Medical Group

will not certify within 24 hours of death

Explore local options:

Alternate MD or RN (EC) or Medical Groupto certify within

24 hours of death

Funeral Home willaccept nurse

pronouncement and

certification within 24 hours of death

Funeral Home willnot accept nurse pronouncement and certificationwithin 24 hours

of death

Explore local options:Alternate MD or

RN (EC) or Medical Groupto attend home

to pronounce andcertify 24/7

EXPECTED DEATH IN THE COMMUNITY PLANNING TOOL

Following discussion with family and physician indicate/circle plan.

Name____________________________

Date_____________________________

MD or RN (EC)or Medical Groupwill certify as soon as possible (within 24 hours of death)

Determine how toget death

certificate toFuneral Home

after completion

Patient’s Name_____________________

• Avoid calling the coroner unless there are reasons to contact them

• Avoid transfer of the body to ER for pronouncement and certification

• It is inappropriate to sign a death certificate prior to the death

Guidelines/Checklist

Family/Caregiver/Agency at Time of Death

• Completed with family/informal caregiver• Numbers to call at time of death:

- professionals

- family/friends• Cultural considerations at time of death

Brochure: When Death Occurs at Home

• Guide for informal caregivers• What to expect; what to do • Information re: appetite, swallowing, sleep,

confusion, breathing, bladder & bowel function, skin colour and temperature

• What will happen at the time of death

Who Introduces the Yellow Folder

• CCAC case manager

• Visiting nurse

• Consider PPS level & initiate discussion

Developed by Victoria Hospice Society

Who coordinates the process?• The CCAC Case Manager will have a checklist of

tasks to be completed.

• As each part of the process is completed, the Case Manager will record it on the checklist

• The Case Manager will address any gaps in the process

• Community Nurses to inform CM when yellow folder is in the home

PALLIATIVE CARE PLANNING CHECKLIST FOR EXPECTED HOME DEATH

DATE (dd/mm/yy)

TIME TASK YES NO N/A

1. Case Manager confirms which funeral home to use, and has permission to phone a)Funeral Home _____________________ Phone# ___________________ b)Funeral Director ___________________ c)Alternative Out of Area Arrangements____________________________ _____________________________________________________________

2. Funeral home is aware that care plan includes home death and has directions to the home

3. Funeral Home agrees to remove body without a completed death certificate* * If answer is “No” a physician or RN (EC) must agree to go to home to certify death.

4. Physician or RN (EC) agrees to go to home to certify death Physician or RN (EC) ____________________Pager # ________________ Phone # _____________________ After Hours # _____________________ Substitute Physician or RN (EC)_________________Pager # ___________ Phone # _____________________ After Hours # ____________________ On Call Physician_____________________ Phone #__________________

5. If answer to #4 is “No”, physician or RN (EC) agrees that the nurse will pronounce death, allowing removal of body to funeral home. Physician or nurse practitioner agrees to provide death certificate to the funeral home within 24 hours (Record contact information in #4 above).

6. Physician or RN(EC) agrees that if all efforts to make contact fail at time of death, the process for the nurse to pronounce death will occur, as in #5 above. * Not applicable if answer to #3 is “No”.

7. Case Manager has confirmed the plan with the nursing service provider

8. Case manager has shared the plan with all other service providers

9. A) Brochure “When Death Occurs at Home” provided to family B) Family member/caregiver understands the procedure for home death 10. A) Client/family directives regarding resuscitation addressed

B) Client’s advance directives, if available, are documented and communicated

11. Confirmation that DNRC is completed and in the home

12. Copies of checklist to appropriate service providers Physician Funeral Home Service Providers

CASE MANAGER___________________________ PHONE # _________________ FAX # ___________________ 1 of 1 Sept 2009

Client Label

Facilitation of planning for expected death in the home will result in:

• DNR status identified appropriately• Plans for pronouncement & certification in place• Family is supported through the dying process

• Avoidance of unnecessary calls to EMS

Questions? Thanks!