The letter raised a number of points. Can you help the team rate their performance?
What went well for Esther’s care?
What could have been done differently?
Spiritual needs Ward staff recognised that Esther had specific rites and customs she would wish to be followed during illness and contacted the hospital chaplaincy service. The best way to determine religious and cultural needs is to ask the patient and/or family members.
Dignity and privacy Staff recognised Esther’s need for privacy. It is important that our clinical areas, procedures and staffing are organised in ways that respect the needs of the patient and family.
Oral care Mouth care was carried out as required to maintain a clean and comfortable mouth. Families can easily carry out mouth care, giving them greater involvement in the care of their dying relative.
Difficult decisions about resuscitation Esther’s family clearly felt they were responsible for making this decision about DNACPR, but this should not be the case. It is for the senior clinician to decide if resuscitation is in the patient’s best interest.
Dealing with preferred place of death The letter indicated Esther would have preferred to die at home. Neither the staff nor family discussed this at the time.
Breaking bad news and preparing the family The family seemed surprised at the suddenness of Esther’s death. This would imply that the team’s communication about Esther’s prognosis had not been clear enough.
Management of symptoms: Common post stroke symptoms include dyspnoea, pain, agitation, constipation, mouth dryness and anxiety. Esther appeared to be very restless on admission and it took some time for staff to manage this.
