The most difficult moments in hospital care often involve the end-of-life decisions patients and family members must make. UF Health Jacksonville seeks to ensure those facing these circumstances receive empathetic support through an initiative called compassionate weaning.
Ravindra Maharaj, MD, a palliative care physician, launched the enhancement in hospital protocols relating to end-of-life care.
“We sought to apply our multidisciplinary approach to palliative care to improve quality of life for our patients and their families,” Maharaj said. “It is our job to do right by the patient through adequate support and education when it comes to their care.”
Maharaj enlisted Pamela Schauben, RPh, manager of inpatient pharmacy services, to assist in revising current procedures for our most critically ill patients.
“Dr. Maharaj and our entire team want to ensure our patients and their loved ones have the most comfortable experience possible,” Schauben said. “Having handled end-of-life care for my own family members, this is a very close and personal matter for me.”
When lifesaving measures are ineffective and attending physicians determine that the patient is dying, the palliative care team is consulted before the option of compassionate weaning is offered.
Patients who opt-in are moved to designated rooms and are removed from life-sustaining equipment. The rooms are much larger in order to accommodate family members, and the unit has fewer visitation restrictions. This allows for a more home-like atmosphere. Patients and families benefit from a peaceful environment — free from the noisy monitoring alarms and interruptions found in most ICU settings. Nurses manage comfort measures to provide patients with a peaceful death.
Valerie Platt, DNP, division director of nursing specialty services, and Seth Osenkarski, MSN, a clinical quality nurse leader, developed guidelines and a workflow to prepare nurses.
“Providing care for our patients and their loved ones in a patient’s final hours is an honor,” said Platt.
Nursing staff in units where a transfer has been requested first obtain a butterfly bag from Osenkarski. The butterfly symbolizes the transition between life and death. The bag contains palliative care and hospice information, along with resources for the patient’s family. Staff work together to gather extra supplies, such as tissues, chairs and amenities to ensure the comfort of the grieving family.
A purple butterfly is placed on the outside of the patient’s door. The butterfly is a universal symbol of hospice care and notifies staff to check in frequently with family members to ensure all needs are being met.
“I believe all patients deserve the dignity of choosing their end-of-life journey,” said Osenkarski. “The designated Progressive Care Unit is an ideal setting due to the lower nurse-to-patient ratio and the availability of quiet rooms where families can gather to honor their loved one and grieve.”