Page 124 - Hospital Authority Convention 2017

Service Enhancement Presentations
HOSPITAL AUTHORITY CONVENTION 2017

F1.6 Better Manage Growing Service Demands 10:45 Room 421

Co-care Service Model for the Care of Patients on Ventilator in General Wards of Queen Elizabeth Hospital
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Ng LY ,Tsang KW ,Liu YW ,Kwong MK ,Kwong MC 1
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Central Nursing Division, Medical Department, Queen Elizabeth Hospital, Central Nursing Division, Kowloon Central Cluster,
Hospital Authority, Hong Kong
Introduction
From July 2014 to June 2015, there are 3,792 ventilator cases in medical wards. Not less than half of the patients on
ventilators are in their end-of-life with life expectancy from days to weeks. Distress of families and patients in the critical
physical condition are observed. Distress encounter when patients on ventilator include fear of critical condition; anxiety of
sudden change of condition; inadequate care related to intubated and symptom which the patients cannot expressed. As a
matter of fact, family may face ethical and psychological dilemma, making them difficult to cope with the discussion of Do-
not-attempt Cardiopulmonary Resuscitation. Some family members may avoid it, or anxiety is aroused. Also, in addition to
taking care of the stressful families, staff may encounter stress when taking care of the patients on ventilators in a congested
environment, not preparing to discuss the end-of-life issue, finding it difficult to arrange flexible visiting hours. Therefore, a
Co-Care Service Model with the collaboration of the Parent Team, Ventilator Team with the support of Palliative Care Team
was implemented in April 2016.
Objectives
Tuesday, 16 May to minimise futile CPR and other life sustaining treatment while patients are at their end-of-life.
(1) To enhance care and promote quality of life for patients who are on ventilator in general wards of Queen Elizebth Hospital; (2)
to facilitate communication with patients, family members and parent team for the decision of treatment plan; and (3)

Methodology
The service was implemented in two phases:
Phase I - Medical department and referrals from non-medical department, except Intensive Care Unit (ICU) and High
Dependency Unit (HDU)Phase II - extend to all adult patients who are on ventilators in all wards, except ICU and HDU
Patients who are on ventilator are under the care of the parent team, supported by the ventilator team and the Palliative Care
Nurse when the parent team agrees the involvement of the APN (PC).

The APN (PC) will:
• Discuss with parent team on the treatment planFollow up with the patient and contact their family member for the goals of
care
• Provide advance nursing care and support family
• Initiate advance care planning if appropriate
• Promote better communication among patient, family and the parent team
• Provide care in the last days of life and after death
• Provide bereavement support by phone and condolence card
Results

(1) Statistics of care provision:
From April 2016 to August 2016, 157 patients in total were assessed. Of which, 101 patients (64%) were recruited
with the parent team’s agreement. Among them, 67 patients’ family members had face to face interviews, and 31
family conferences were conducted for emotional support; discussion and decision making of the treatment and care
preference. After thorough and detailed discussions, 28 ventilated patients had undergone terminal extubation with the
agreement of both parent team and their families.
(2) Recipient satisfaction survey was conducted in August 2016:
There was 30% returned rate and all the respondents were highly satisfied and satisfied with the service.

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