Read on Twitter
COVID is putting significant pressure on practically every system across the NHS.
It’s important for us to recognise that things will & are slipping through the cracks; through the stress fractures in a system that is fire fighting
A thread
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It’s important for us to recognise that things will & are slipping through the cracks; through the stress fractures in a system that is fire fighting
A thread
/1
I’d like to reflect on one such ‘slip through’ - historic, heavily edited/redacted with nothing identifiable other than perhaps a relatable context...
An incident with elements that perhaps on a better day, would have been avoided.
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An incident with elements that perhaps on a better day, would have been avoided.
/2
It’s probably fair to say that it wasn’t the optimum result. Given the opportunity, there may have been better communication before the event which could have prevented a lot of distress & confusion
We need to talk about dying
#havetheconversation
(Thanks to @DrLindaDykes)
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We need to talk about dying
#havetheconversation
(Thanks to @DrLindaDykes)
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Called to an 86F OOHCA
Cat1 “CPR in progress”
- personally, this makes my heart sink a little bit
Third unit on scene, minutes behind
Cachexic, hospital bed, poorly
Patient on the floor CPR in progress
Family on scene - distraught
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Cat1 “CPR in progress”
- personally, this makes my heart sink a little bit
Third unit on scene, minutes behind
Cachexic, hospital bed, poorly
Patient on the floor CPR in progress
Family on scene - distraught
/4
Advised by colleagues that there is no DNACPR, downtime less than 15minutes... the family want us to try
- my heart sinks a little further
In a world where time, situations, capacity or COVID allowed, I’d like to think there may have been conversations prior to this event
/5
- my heart sinks a little further
In a world where time, situations, capacity or COVID allowed, I’d like to think there may have been conversations prior to this event
/5
I’m told that they were last seen 15 mins ago ‘well’ and then they were found like this
The family phoned 999 and followed our advice diligently - 1 & 2 & 3 & 4
/6
The family phoned 999 and followed our advice diligently - 1 & 2 & 3 & 4
/6
A brief conversation about futility and the patients wishes had occurred during the first few minutes before I’d got there - the responders were clearly all on the same page thinking something similar - “but the family wanted them to try”
/7
/7
And that is right. That’s what family’s should want. They should want us to do everything we can to save their loved one... but we know that without conversations prior there is disparity regarding what ‘doing everything we can’ means
/8
/8
It’s tough to walk into the room, expected to be the saviour and to convince everyone that this is the ‘wrong thing to do’
It’s hard to have a gentle, thoughtful ‘end of life’ conversation to the background noise of metronome and LSU
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It’s hard to have a gentle, thoughtful ‘end of life’ conversation to the background noise of metronome and LSU
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This is one that’s fallen through the crack. A conversation missed, most likely through no fault of any individual. But one that we should consider a failing anyway
/10
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So there are three options...
1) Stop immediately (or don’t start) and manage the fall out and expectation mismatch afterwards
2) Open the ALS manual and start a 20 minute timer
or
3) Do the hard thing
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1) Stop immediately (or don’t start) and manage the fall out and expectation mismatch afterwards
2) Open the ALS manual and start a 20 minute timer
or
3) Do the hard thing
/11
I witnessed colleagues meet the family expectation and do everything they could whilst the history was gathered
We learnt of the recent hospital discharge, we learnt of the undocumented referral to a service the family didn’t understand... palliative care
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We learnt of the recent hospital discharge, we learnt of the undocumented referral to a service the family didn’t understand... palliative care
/12
I watched colleagues have conversations about realism, outcomes and expectations.
About patient and family preferences.
And I saw a family afforded a gentle opportunity to come to terms with what was happening without ever feeling like we didn’t try.
/13
About patient and family preferences.
And I saw a family afforded a gentle opportunity to come to terms with what was happening without ever feeling like we didn’t try.
/13
In this instance, they needed to see us try
They all needed to understand why we should stop
They made the informed decision to do so
They did the right thing
We did the right thing
And that stress fracture was prevented from being able to cause any harm
/14
They all needed to understand why we should stop
They made the informed decision to do so
They did the right thing
We did the right thing
And that stress fracture was prevented from being able to cause any harm
/14
Please. Do not shy away from these conversations
With your family, with your patients, with your students, juniors, systems...
Incidents like this will slip through and we’ll do our best to salvage them at ‘ground zero’ - but on the back foot
/15
With your family, with your patients, with your students, juniors, systems...
Incidents like this will slip through and we’ll do our best to salvage them at ‘ground zero’ - but on the back foot
/15
On that day, my colleagues did their very best
They were kind
To my NHS colleagues; keep it up. Look after each other. Have the tough conversations. Be kind.
/end
They were kind
To my NHS colleagues; keep it up. Look after each other. Have the tough conversations. Be kind.
/end
