CME Opportunities
Medscape Resources: ‘Introduction to the Last Hours of Living: Practical Advice for Clinicians’
In the palliative care resources section of its website, Medscape.com offers a CME/CE activity entitled, “Introduction to the Last Hours of Living: Practical Advice for Clinicians.” The material is excerpted and adapted from a teaching module edited by Linda Emanuel, MD, et al, for The EPEC Project (www.epec.net).
Main topics include:
• Introduction to the Last Hours of Living
• Preparing for the Last Hours of Life
• Physiologic Changes and Symptom Management
• Two Roads to Death (Usual or Difficult)
• When Death Occurs
• Notifying Others of the Death
• Pronouncing Death
• Summary of Take-Home LessonsIn the summary section, the editors offer 17 key points to keep in mind, such as:
• “There is only one chance to get management of the last hours right.”
• “Patients in the last hours of life usually need skilled care around the clock. The environment must allow family and friends ready access to their loved one in a setting that is conducive to privacy and intimacy.”
• “Advance preparation and education of professional, family, and volunteer caregivers is essential. They should also be knowledgeable about the potential time course, signs and symptoms of the dying process, and their potential management. The physician or nurse needs to help family members understand that what they see may be very different from what the patient is experiencing.”
• “Most patients...reduce their fluid intake, or stop drinking entirely, long before they die. Dehydration in the last hours of living does not cause distress and may stimulate endorphin release that adds to the patient’s sense of well-being.”
• “It should be presumed that the unconscious patient hears everything.”
• “Dying in an institution presents particular challenges. Priorities and care plans at the very end of life differ from those priorities and plans focused on life prolongation and cure.”
• “Planning discussions should cover personal, cultural, and religious traditions, rites, and rituals that may dictate how prayers are to be conducted, how a person’s body is to be handled after death, and when/how the body can be moved.”
Reprinted with permission from Quality of Life Matters®, copyright 2009.
Published by Quality of Life Publishing Co., Naples, FL.
