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Management of the final 24 hours
Irish Medical Journal
|September 1, 1992
Summary
Improving end-of-life care involves better communication between hospitals and hospices. Key symptoms like pain, secretions, and agitation require optimized palliative medication and family support for optimal patient comfort.
Area of Science:
- Palliative Care
- Geriatric Medicine
- End-of-Life Care
Background:
- Optimal management of the final 24 hours of life is critical for patient comfort and family support.
- Effective communication and timely interventions are essential in hospice and end-of-life care settings.
Purpose of the Study:
- To review the management of the final 24 hours of life for 100 hospice patients.
- To identify areas for improvement in symptom management and patient care during the pre-terminal phase.
Main Methods:
- Retrospective review of 100 patient cases in Our Lady's Hospice.
- Analysis of symptom frequency and medication use in the final 24 hours of life.
Main Results:
- Pain, respiratory secretions, and agitation are the most distressing symptoms.
- Standard palliative medications (e.g., morphine) are commonly used, with newer options (hydromorphone, midazolam) showing benefit.
- Earlier subcutaneous hyoscine and avoidance of intramuscular diazepam may improve agitation management.
- Addressing hyoscine toxicity and pyrexia is important for pre-terminal agitation.
Conclusions:
- Enhanced communication between general hospitals and hospice/home care teams regarding patient transfers is recommended.
- Optimizing medication strategies, including earlier use of subcutaneous hyoscine and appropriate management of side effects, can improve symptom control.
- Comprehensive care must include attention to the needs of the dying patient's family.
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