Continuous Palliative Sedation Until Death: The Development of a Practice Protocol for Nursing Homes

Area of Science:

• Palliative Care Medicine
• Geriatric Care
• Healthcare Quality Improvement

Background:

• Continuous palliative sedation until death presents unique challenges in nursing home settings.
• Existing practices may not adequately address the specific needs of residents and staff in these environments.

Purpose of the Study:

• To develop a protocol aimed at improving the quality of continuous palliative sedation until death in Belgian nursing homes.
• To address identified barriers and enhance care coordination and communication.

Main Methods:

• Protocol development based on the Medical Research Council Framework.
• Systematic review of improvement initiatives and focus groups with 71 healthcare professionals.
• Refinement and review by 70 additional healthcare professionals through expert panels.

Main Results:

• A 7-step protocol was developed, focusing on medical/social clarification, communication, care organization, sedation, and support.
• The protocol includes comprehensive recommendations on coordination, collaboration, and communication with residents and their families.
• It addresses specific needs for supporting fellow residents and facilitating goodbyes.

Conclusions:

• A practice protocol for continuous palliative sedation until death, tailored for nursing homes, has been successfully developed.
• Future research should prioritize implementation strategies and effectiveness evaluation.
• The protocol aims to enhance end-of-life care quality in the specific context of nursing homes.