ADMINISTRATION OF DRUGS TO THE
DYING
Medication Administration
- The inability to administer a
medication at the end of life is a
barrier to providing adequate
patient care. Intravenous (IV) may
access may be discontinued as a
result of end-life-goals and oral
access may be limited because of
impaired swallowing ability or
altered mental status. In the
absence or limited availability of IV
and oral access, alternative routes of
medication administration can be
used. Alternative medication
formulations used at the end of life
can allow medications to be
delivered bucally, or topically (table
I). In emergent situations or when
alternative routes of administration
are not possible, non-IV parenteral
routes may be considered.
Advance Directives
- are instructions that indicate
healthcare interventions to initiate
or withhold, or that designate
someone who will act as a surrogate
in making such decisions in the
event that we lose decision-making
capacity. Such directives can be
considered as a kind of informed
consent for future interventions.
Advance directives support people
in making decisions on their own
behalf, and help to ensure that
patients have the kind of end-of-life
care they want.
Nurses Responsibilities
- Nursing’s advocacy role in this
regard includes informing other
health team members of the
presence and content of advance
directives, alerting appropriate team
members to changes in patient
wishes or to evidence of changes in
the patient’s decisions-making
capacity, and intervening on behalf
of the patient when wishes
expressed in advance directives are
not being followed.
Legal and Medical Purpose Definition
Death is the irreversible cessation of
all the following:
1. EEG assessed flat-line total cerebral
function;
2. Spontaneous function of the
respiratory system; and
3. Spontaneous function of the
circulatory system
Do Not Resuscitate Orders
- The general practice regarding CPR
is that it must be initiated unless; (1)
it would clearly be futile to do so, or
(2) the practitioner has specific CPR
in the event of a cardiac or
pulmonary arrest. As noted
previously, DNR orders are written
directives placed in a patient’s
medical record indicating that the
use of cardiopulmonary
resuscitation is to be avoided.
- DNR orders should be documented
immediately in a patient’s
healthcare record, noting the reason
the order was written, who gave the
consent and who was involved in the
discussion, whether the patient was
competent to give consent or who
was authorized to do so, and the
time frame for the DNR order.