End Of Life Care ( EOLC)

                                                              (Photo credit :Pixabay)

A Stage in one patients life may come, when he/she does not respond to further medical treatment in positive manner. It means that, no chance of recovery or return to normalcy gets noticed even if very special, personal and precise treatment is going on.  Even changing course of clinical treatment by specialised doctors do not have any positive impact on patient's health.

EOLC , that is End of Life Care , comes handy and very useful at this situation. The basic aim of EOLC is to reduce pain considerably, to reduce unnecessary burden of medical treatment and to guide patient to his /her Natural death by peaceful and calm manner and surrounded by his /her relatives/near and dear ones instead of comparatively unknown persons including unnecessary hospital staff/healthcare workers too.

National Accreditation Board for Hospitals and Healthcare Providers (NABH) focuses about it. "End of life care is a person centered, personalized and family oriented perception of "Good Death " which encompasses all aspects of comprehensive care of an individual' at his or her end of life."

So when does EOLC Commence? or has to begin ?

End Of Life Care starts when :-

1. When treating physician or group of physician feel that any more medical treatment is futile or no more use , the topic can be discussed together and EOLC can be initiated. Medical futility is a clinical decision that has consensus across all the treating physicians and has given timely information to family members.

2. When to maintain ongoing treatment becomes fruitless and there are no means do alter or change course of treatment , no possibility of any hopeful wayout by any type of medical treatment . In that situation maintaining treatment , on the contrary may be become burdensome to his/her peaceful few days/hours.

So what is role of  quality personnel in this regard ? . Yea , quality person has a lot to do with EOLC.

He/she can and must confirm :-

a) Any form of communication about decision to commence EOCL. It can be  in the form of orgnisational email stating condition of patient and asking for EOCL.

b) Any written document in this regard.

c) Has dead patient was surrounded by his relatives at his/her end time.

d) Has patient death was peaceful ?

e) Has patient  unnecessarily admitted to ICU if was absolutely not needed , after proving medical futility ?

f) If patient / relatives wanted to move to his own home knowing medical futility and thereby patient end is near , had permission given immediately ?

g) Had relatives signed documents given permission to EOCL ? or was there video recording ?

h) Was patient able to meet and spend time with near and dear ?

i) Was post death documented history of patient available and it shows smooth flow towards  'Allowing Natural Death ' (AND)

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j) If patient had wished to perform some spiritual acts before death , or else had wished some kind of control on his/her treatment ....Say , " Please give us ( with my near and dear ones) some time together, I do not want any hospital staff to disturb us " ..... has his/her wish followed ?

k) Has there Hosptial policy for EOLC?

l) Does hospital has physical isolated space where patient can be taken for his last stage upon his/her and relatives readiness ?

m) Is  there 'medical futility' document ?

n)  Had hospital has issued some essential medicine to control pain of patient during EOLC ?

o) Last but not least 'had patient received dignified/peaceful/natural death ?

The main misconceptions about EOLC :-

 It is applicable only to ICU patients. 

No, EOLC can be initiated anywhere where patient ward exists. It can be General Ward , ICU or even semi special or Special wards.

These are some of basic concepts in EOLC quality control angle. Tried to put in simple /Non medical language. Hope you liked it. Please inform us. Thanks.