Caring when it counts

Original Source

by Barbara Harding

DEATH is a frightening subject that few of us like to think about, never mind discuss, but it comes to us all eventually and often in an unexpected manner. Ensuring our environment offers us grace, dignity and respect in our final hour is therefore important in terms of providing solace, comfort and support. However, in our current hospital framework, this service is lacking.

For this reason, the Hospice Friendly Hospitals Programme (HfH) was initiated by the Irish Hospice Foundation (IHF) to act as a resource for employees in 41 hospitals nationwide – from catering and administration staff, to cleaning and medical personnel – to ensure they are meeting the needs of the terminally ill or dying patients on their wards.

Launched in 2007 at a cost of EUR10m, the programme went national after a successful pilot project at Our Lady of Lourdes Hospital in Co. Louth two years ago. The pilot provided the HfH with developed standards of practice in end-of-life care, focusing particularly on four key themes: integrated care, communication, dignity and design and patient autonomy.

It follows a survey released by the IHF in 2004, which showed 67pc of Irish citizens would prefer to die at home, compared to just 10pc who would rather be in hospital. Some 80pc of participants also said hospital care needed serious improvements to cater for the terminally ill or dying, while 51pc called for a more comprehensive and focused public discussion on the topic.

Some 30,000 people die in Ireland annually, of which 40pc pass away in acute hospitals that are buckling under pressure. This is resulting in poor standards for end-of-life patients. Letters of complaint continually arrive at the office of the Ombudsman by outraged families in this regard, but deputy manager of the HfH Shelagh Twomey says hospital employees are not to blame.

“Staff members are struggling and hospitals are bursting at the seams; some have an occupancy rate of 140pc. Also, with the Health Service Executive embargo, employees are not being replaced when they are out sick, so morale is extremely low.”

She adds: “There remains, however, a great willingness on the ground to get this programme right. We are trying to apply hospice principles and philosophies to end-of-life care in hospitals. We’d like to see a more strategic approach, for example, providing a room for end-of-life patients, so they can have some privacy with their families. At present, only 6pc of Irish hospitals have single rooms; our research shows it should be 50pc.”

The HfH has developed standing committees to cover the issues of death, dying and bereavement from an educational and training perspective. It has also amassed a task force made up of: 10 development co-ordinators to work with acute and community hospitals, assisting and supporting employees in best practice; a project manager and project employee to work in three of the main Dublin hospitals (the Mater Misericordiae University Hospital, Connolly Hospital and the Royal Hospital) to develop a framework of standards; and a development-support manager to provide education and training at participating hospitals.

“Employees are telling us they welcome more training in breaking bad news to patients and families. They would also like to learn much more about this area, such as how to decorate a mortuary so it’s less sterile,” says Twomey.

“It’s important for us to start the journey in the hospital and see where the gaps are, so everyone knows what everyone else is doing. If a dying patient comes into A&E, we assess how they can be fast-tracked onto a ward. We also look at what happens if a patient dies on a ward – are they given a private room? Is there good communication with other concerned patients on the ward? This system isn’t integrated enough at the moment.”

She adds: “We can’t stop people dying, but we need a system in hospitals to make the process better for everybody concerned.”