Team meeting

Charge Nurse:

• Speech bubble: I hope you have had a chance to review the letter from Esther’s family. I think it raises a number of issues we should consider.
• Thought bubble: It’s unfortunate no one seems to have asked about the advanced care plan (see Additional Information box for definition). I hope no-one gets defensive as this is an opportunity to improve our practice.

Junior Doctor:

• Speech bubble: I was surprised Esther’s family felt responsible for the Do not attempt cardio-pulmonary resuscitation decision. Perhaps we need to think about how to communicate this.
• Thought bubble: I’m sure I never suggested it was their decision. These sensitive discussions can be so easily mis-interpreted.

AHP Team Lead:

• Speech bubble: I doubt we would have been able to get Esther home in time but we should look at how we respond to patient’s previously expressed wishes.
• Thought bubble: I need to investigate what is available locally to support early discharge home with palliative care rather than presume this is impossible.

Consultant

• Speech bubble: Recognising the dying phase is often not straightforward, but I agree we need to ensure families are prepared for the worst, even if we are hoping for the best.
• Thought bubble: I wonder if the team give consistent messages?

Staff nurse:

• Speech bubble: Did we take too long to ensure Esther was comfortable? I’d like to look back at how quickly we put the care plan in place.
• Thought bubble: I remember Esther’s first 24 hours with us. I wondered if she was in pain, she was so agitated.