MADRID, 5 One. (EUROPE PRESS) –
La Sociedad Española de Medicina Interna (SEMI) and la Sociedad Portuguesa de Medicina Interna (SPMI) have a document to establish the consensus, homogenize and 37 recommended on norms of good clinical practice in the attention to patients at the end of life .
In the elaboration of this work, published in the ‘Spanish Clinical Review’ and its main objective, it has defined practical recommendations for internal medicine physicians who care for patients who fall during hospitalization, participating in a committee of experts trained 10 portugueses), of the 11th century internal medicine and a resident of Internal Medicine.
The recommendations are grouped in blocks: ‘Patient identification’; ‘Knowledge, values and preferences of the patient’; ‘Information’; ‘Patient Needs’; ‘Attention and care’; ‘Palliative sedation’; and ‘Atención tras la muerte’.
To evaluate and evaluate the degree of consensus and strength of the recommendations, 150 experts (125 from Spain and 25 from Portugal) are invited to participate in their median evaluation using the Delphi method in two rounds. Each participant sends a questionnaire with 37 affirmations for those who need to quantify their degree of disagreement or disagreement on a scale of 1 to 5.
A total of 105 participants and hubo consenso fuerte and 33 recommendations (89.2%) and 4 and 10 (10.8%) recommendations. Asimismo, it is counted with the participation of the Working Groups of the Multidisciplinary Patient and Edad Avanzada and the Palliative Care Teams of the SEMI and the Palliative Care and Bioethics Groups of the SPMI.
Specifically, the experts agree that at the time of the introduction, and in the repeated form during the hospitalization, the palliative care needs of each patient are evaluated, and they are identified in those situations in their last days of life.
To evaluate the needs of palliative care and identify patients in their last days of life it is recommended to use validated instruments and scales, and the condition of care that specified or in the last days of life should be registered.
In the same way, it is established in the document, in patients with nurses in advanced situation, who enter the hospital, have to evaluate their knowledge of the nurse and explore their values and preferences, as well as their families.
CONSULT THE REGISTER OF VOLUNTEERS / DIRECTIVE ANTICIPADAS
The experts also report the importance of registering in clinical history the knowledge of the nurse, the values and preferences of the patients with patients in advanced situation who are admitted to the hospital and their families.
In addition, it is necessary to consult the register of early volunteers / assistants when entering a hospital with a patient in an advanced situation, as well as when identifying a person in their last days and not being able to express their volunteers.
In patients in their last days of life, the organizations concerned inform the family and the caregivers of the near-death situation; know the limits of confidentiality established by the patient during his last days of life; record in clinical history the process of informing the patient and his relatives; and provide information to the patient as well as to his / her relatives maintaining intimacy and privacy.
In this sense, the services also have at their disposal an information and time appropriation for communication with the patient and the family. In addition, the experts recommend evaluating and recording systematic form in clinical history the presence of symptoms and the degree of control of the diseases.
All services also need to receive updated clinical treatment recommendations and ultimate days, oriented to the comfort and control of the symptoms; and the adequacy of the therapeutic plan to the actual situation of the patient and the limitation of the therapeutic effort should be shared by the assisting staff and consensual with the patient and / or his family, and record the justified form in the clinical history.
EVITAR PROCEDIMIENTOS QUE NO APORTEN BIENESTAR AL ENFERMO
On the other hand, in the document submitting the importance of which patients in their ultimate days of life avoid all examinations and diagnostic procedures that do not contribute to the disease, the convenience of resuscitation orders is recorded and registered. in the clinical history, and the spiritual needs of the infirm and the family.
At the same time, recommend attending to these patients in an individual accommodation, facilitate the familiar care and count with a care plan of Nursing, which should include, at least, the care of the skin, the stomach, the food, the elimination , the respiratory cartridge, the discharge and the handling of pain and other symptoms of the terminal injury.
In the last days, patients will receive a structured communication of the assisted transitions (guards, turn shifts, week ends, vacations), and access to religious and psychological facilities will be facilitated.
In addition, patients in their last days of life with refractory symptoms should value the need for palliative sedation, and the subject tends to otorgar, well in verbal mode or in written documents, the consent explicitly for the sedation if competent, and acting in accordance with this order, the register of prior instructions shall be consulted, the pre-existing expressions of the patient shall be valued to his family or allies and, in his absence, the settlement shall be concluded with the family, always registered at the clinical history.
In the consensus signal also that the indication of palliative sedation should be deliberated by the therapeutic team; that all services should have a palliative sedation protocol; and that clinical guidance standards for palliative care include indications, refractory sinuses to deliver, pharmacies, dose of induction, maintenance and recovery, and monitoring of the level of sedation.
To monitor the level of sedation using the Ramsay scale and other similarities, all cases involving palliative sedation should be recorded in clinical history and all services should follow a post-mortem care protocol.
Finally, throughout the patient’s death, the experts recommend paying close attention to the immediate situation of the relatives, and identify, before and after the death, the situations of complicated duel.