Documenting a palliative care review
Inpatient reviews, family meeting notes, and letters to the GP and the community palliative team.
Day five of a symptom admission
Day five, metastatic pancreatic cancer, admitted with pain and vomiting.
Pain controlled on the driver, hydromorphone 6 mg over 24 hours, two breakthrough doses yesterday.
Vomiting settled on haloperidol 1 mg subcut at night. Bowels opened yesterday with macrogol.
Family meeting this afternoon with her daughter and son. She wants to go home. Comfort is the goal, not for resuscitation, that's documented.
Home Thursday with the driver running, community palliative care to visit daily for the first week.
Progress
Day 5. Metastatic pancreatic adenocarcinoma. Admitted with pain and vomiting.
Symptoms
- Pain controlled: CSCI hydromorphone 6 mg/24 h, 2 breakthrough doses in 24 h
- Vomiting settled: haloperidol 1 mg SC nocte
- Bowels open (macrogol)
Goals of care
Family meeting today with daughter and son. Patient wishes to go home. Comfort-focused care. Not for CPR (documented).
Plan
- Discharge Thursday with CSCI
- Community palliative care daily visits for the first week
Letters to the family, GP and community team
- Family update
- What was agreed at the meeting, what to expect at home and the number to ring at any hour.
- Letter to the GP
- The goals of care, the resuscitation decision, the driver contents and breakthrough doses, and who prescribes from here.
- Letter to the community palliative care team
- Driver contents with the date it was last changed, breakthrough orders and the family's understanding.
