Beruflich Dokumente
Kultur Dokumente
April 5 2017
Overview
• John’s Story
• Receiving the Request
• Examining Values and the Paradigm Shift
• Making a Referral
• Legislation, Policy + Legal Requirements
• Conscientious Objector Process
• Focus on the Resident + Supporting the Family
• Support to Co residents, Staff and Others
• Current Status of Legislation + Legal Challenges
John Taylor’s Story
Passion for
Rock
Climbing
John Taylor’s Story
A Daughter’s
Wedding
John Taylor’s Story
Solving a
Problem
John Taylor’s Story
Together from
beginning to
end
The Request
Local Anaesthetic
• Lidocaine without epinephrine 20 mg/mL concentration
• 2 mL or 40 mg in a syringe
• Provide 1
Medication Schedule
Coma Inducing Agent
• Propofol 10 mg/mL concentration
• Provide 4 - 50 mL bottles
• Require 2 kits of 1000 mg each (2nd kit to be returned unused)
• Need 2 - 60 mL syringes
Neuromuscular Blocker
• Rocuronium bromide 10 mg/mL concentration
• Provide 4 - 10 mL bottles
• Require 2 kits of 200 mg each (2nd kit to be returned unused)
• Need 2 - 10 mL syringes
Also need NaCl 0.9% saline solution (1 litre) with IV tubing and extra 10
mL syringes and antiseptic swabs.
Role of Senior Leader
We are a Home
Consider:
• Education for residents and families
• Opportunity to discuss personal values and beliefs
• Opportunity to “conscientiously object”
• Informing them of the day’s routine; any staff changes
• Providing support and grief counselling
• Opportunity to be part of Honour Guard
Policy
Early days: Interim
Absence of regulations and gaps in legislation
Development – Relied upon:
• Interim guidelines published by CPSO, CNO, OCP
• CMA Principles-based Recommendations
• Discussion Papers by Joint Centre for Bioethics, U of T
• Provincial-Territorial Expert Advisory Group on PAD
• Report of the Special Joint Committee on PAD
• Palliative and End-of-Life Care Provincial Roundtable
Report
Policy
• Walk through day’s events with team two to three days in advance
and with family one day in advance
• Prepare for the final question
• Add additional PSW and registered staff on the Home Area
• Provide more frequent breaks for staff involved if time out is
required
• Assign a senior staff member to the family and visitors ensuring
they are supported
• Hospitality – stay over suite available, refreshments and meals,
dedicated room for visiting if large numbers expected
• Flowers for the family
Best Practices
• Honour the resident’s last wishes – Scotch Party! Persons present at
time of death and request passage to be read at Honour Guard
• Communicate daily with your care team members, resident and
family
• Provide a point of contact for staff for more information
• Create a checklist for equipment, supplies and required
documentation
• Confirm all documentation is complete prior to clinicians leaving
the Home
• Provide a structured debrief for staff and ongoing
• Invite residents and visitors to be part of the Honour Guard
Lessons Learned
Timelines
resident’s wishes
The Past: Lessons Learned
Refection Period
Witnesses
• Witnesses cannot:
directly provide health care services or personal care to the resident
know or believe they are a beneficiary under a will (excludes most family members)
Health care provider in the home, if they do not own the home and are not directly involved in
resident’s health care or personal care
• Home’s policy
Conscientious Objections
Record-Keeping
insufficient detail
• Use of Ministry’s Clinician Aids has been helpful – keep in resident’s file
Drug Protocol
• Sex:
– Female: 151
– Male: 154
• Age:
– Average Age: 74
– Youngest: 35
– Oldest: 101
Middlesex County 13
The Present: Legal Challenges/Reviews
advance requests
Standing Committee on Finance & Economic Affairs held public meetings on March
23 and 30, 2017
• Coroners Act
Where a person dies from MAiD, physician or NP who administered
treatment must notify the coroner
• Must provide any information about the facts and circumstances relating to
the death that Coroner considers necessary
• Any other person with knowledge of the death must provide such
information on the request of the coroner
Clarifies that coroner does not need to sign the medical certificate of
death for MAiD deaths, unless the coroner investigates
Ontario’s Care Coordination Service