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Terminal discharge

  • Introduction

    A terminal discharge is defined as a discharge home when patients are critically ill and likely to pass away within short hours or days.

    For seriously ill patients with little chance of recovery, it is a good practice to proactively discuss about patients’ preference of place of death to facilitate early planning and coordination.

Terminal discharge

Terminal discharge

  • Introduction

    A terminal discharge is defined as a discharge home when patients are critically ill and likely to pass away within short hours or days.

    For seriously ill patients with little chance of recovery, it is a good practice to proactively discuss about patients’ preference of place of death to facilitate early planning and coordination.

  • Factors to consider for terminal discharge

    • Patient
      • Has patient expressed a desire to die at home?
      • Will symptoms be manageable at home?
      • Could patient die enroute?
    • Family/Caregiver
      • Are there caregivers available? How many are required?
      • Is the family able to cope physically and emotionally with patient’s care and demise?
      • Is the family aware of what to expect (e.g. about the signs of dying), how to respond, and who to contact when patient dies?
    • Resources/Equipment
      • What equipment is needed (e.g. hospital bed, oxygen concentration)?
      • Should referral to a home hospice team be made?
        (Note: Please note that new referrals are seen during weekdays only, and it is not practically feasible for home hospice teams to see new patients that are expected to demise within hours on arrival at home or over weekends or public holidays. For patients already known to home hospice, please inform them in advance of the discharge.)
      • Consider private nursing contacts for caregiving, if necessary and affordable
      • For overseas terminal discharges, contact palliative care teams for advice
  • Terminal discharge checklist

    This checklist might be helpful when facilitating a terminal discharge.

    DoctorsNurses
    • Achieve consensus about terminal discharge between family and medical team
    • Order controlled drugs correctly
    • Consult Palliative team if a syringe driver^ or disposable infusor is required
    • Supply adequate medications (usually 3-7days supply)
    • Make home hospice care referral*, if not already known
    • Contact home hospice team and give adequate information
    • Fax discharge summary to home hospice
    • Give 2 copies of discharge summary to family and home hospice service
    • Write memo to Ambulance Officer (to send patient home and not to Emergency Department in case of demise en-route)
    • Write memo to GP (with information to help GP write up death certificate)
    • Insert subcutaneous needle, if infusion is required
    • Provide caregiver training as needed
    • Book ambulance
    • Arrange home oxygen and other equipment, if necessary
    • Provide relevant brochure, if available
    • Liaise with pharmacist with regards to discharge medications

    Note: Terminal discharge protocols might be available at your institution; ask if in doubt.

    ^If syringe drivers are used, the Palliative Care Team will counsel family about how to return the syringe driver.

    *May not be appropriate to contact home hospice (unless already known to the service) if expected demise of patient is hours on arriving home or terminal discharge is over a weekend or public holiday.

  • Acknowledgement

    Above information is adapted from terminal discharge processes at the following institutions:

    • National Cancer Centre, Singapore
    • National University Cancer Institute, Singapore
    • National University Hospital
    • Tan Tock Seng Hospital
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Contact: lcpc@duke-nus.edu.sg

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