Care of Comatose and Vulnerable Patients

Care of Comatose and
Vulnerable Patients
Assessment and Care of
Patients at End of Life
Presented BY:
JHESSIE L. ABELLA, RN, RM, MAN, CPSO, CPHMG, SMRIN
CARE OF COMATOSE AND
2
VULNERABLE PATIENTS
PURPOSE:
 To identify patient populations at risk.
 To standardize the care provided to
comatose and vulnerable patients.
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VULNERABLE PATIENTS
POLICY STATEMENT:
 All Al-Khafji National Hospital shall adhere to Article (2/11) of the Saudi Council for
Health Specialties by law, Ethics of the Medical Profession, Conditions of persistent
irreversible coma regarding the care of comatose patients.
 Comatose patients shall not be treated as a patient suffering from terminal disease.
 Comatose patients are considered as lacking legal liability and mentally
incapacitated.
 The care of comatose patients should continue.
 Identification of the comatose patient with no identification shall be done in
accordance with policy Correct Patient Identification.
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VULNERABLE PATIENTS
POLICY STATEMENT:
For COMATOSE Patients
incapacitated.
VULNERABLE PATIENTS are those patients who, for
any reason, are not able to protect or take care of
himself/herself, against exploitation or harm. Such
patients are prone to various risks within the hospital,
such as fall, injury, neglect, abuse, medical errors and
acquiring of infections.
WHO ARE THESE PATIENTS?
 Children
 Adolescent
 Elderly
 Patients in severe pain
 Suspected victims of abuse, neglect, and domestic violence
 Patients suspected of drug and/or alcohol dependency
 Women in labor
 Women experiencing terminations in pregnancy
 Terminally ill and dying patients
 Infectious disease and Communicable disease
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VULNERABLE PATIENTS
POLICY STATEMENT:
For VULNERABLE Patients
incapacitated.
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VULNERABLE PATIENTS
High Risk Services in KNH

 Emergency Patients
 Comatose Patients
 Patients on Life Support
 Care of Patients With A Communicable Disease
 Care of Patients In Restraints
 Care of Vulnerable Patient Populations
 Abuse and/or Neglect
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VULNERABLE PATIENTS
Physicians should have a clear understanding of basic ethical concepts

when they are considering decisions to proceed with, refrain from or
discontinue a medical treatment.
 Autonomy
 Beneficence
 Non-maleficence
 Equity
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VULNERABLE PATIENTS
Patients have a right to a “death with

dignity.” Allowing a dignified death to
occur naturally is a moral act.
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CARE OF COMATOSE
Conditions of Persistent Irreversible Coma:

A patient in such condition neither feels what is happening around
him, nor responds to anything or action around him, but his
condition is not classified as one of a (terminal disease) since
his/her life in state of coma could continue for several months or
even for years, thus exceeding the limit of six months specified as
the limit for (terminal diseases).
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CARE OF COMATOSE
WHAT IS OUR RESPONSIBILITY?

 The physician, nurses and other healthcare providers should
continue to perform their duty of treatment and medical,
nursing care.
 To Protect patient from harm with the following procedures
that applied:
 An attendant at all times ( preferably a nurse ,but can be a
family member or care giver)
 Side rails of the bed in place.
 Airway management ,equipment at hand
 Suction equipment at hand.
CARE OF VULNERABLE
13
PATIENTS
For Vulnerable Patients:
 Assessment of the patient will be age specific and have
sufficient detail to identify if the patient is vulnerable or at risk.
Assessment and reassessment shall be done according to
policies Outpatients and Emergency patients Nursing
Assessment and Reassessment, Initial Medical Assessment and
Reassessment, Inpatients Nursing Assessment and
Reassessment, Prevention of Patient Fall.
CARE OF VULNERABLE
14
PATIENTS
 The identified vulnerable patients will be under close
monitoring at all times during their hospitalization to minimize
risks of health care services.
 All healthcare providers will maintain a safe environment,
related but not limited to:
 Equipment
 Wheelchairs
 Bed rails
 Mobility needs
 Fall precautions
CARE OF VULNERABLE
15
PATIENTS
 To protect vulnerable patients, the vulnerable patient alert will
be displayed on the patient’s door as soon as possible after
the initial assessment is completed (This alert is not used
routinely in the Nursery or NICU as all patients in these units
are considered vulnerable patients).
 Details of the patient’s risk factors and interventions to protect
the patient are documented in the nursing care plans and the
multidisciplinary notes
Care of Comatose and
Vulnerable Patients
Assessment and Care of
Patients at End of Life
Presented BY:
JHESSIE L. ABELLA, RN, RM, MAN, CPSO, CPHMG, SMRIN
CARE OF PATIENTS AT
END OF LIFE
PURPOSE:
 To meet patients and family’s needs at
end of life.
CARE OF PATIENTS AT
END OF LIFE
POLICY STATEMENT:
 Dying patients and their families shall assess and
reassessed according to their individualized needs.
 Assessment findings shall guide the care and
services provided.
 Assessment findings and care are documented in
the patient’s medical record
CARE OF PATIENTS AT
END OF LIFE
For terminal/incurable diseases and where

recovery has become hopeless. How is
Medical Decision MADE?
 The medical decision that the condition is terminal, and that
recovery of the patient from his disease is hopeless shall be by
consensus of three consultants whose opinions bear high
consideration in such condition (see policy Do Not Resuscitate for
details)
CARE OF PATIENTS AT
END OF LIFE
Principles of dealing with terminal incurable

disease and dying patients: The patient
should:
 Be respected
 Receive the appropriate medical care in neither excessiveness nor negligence,
irrespective of the seriousness of his disease.
 Hopelessness of patient's recovery should not lead to reduction of the physician's
visits, or the care of administering the medicine prescribed for him.
 The patient and his relatives' psychological condition should be taken into
consideration by the healthcare provider during the entire period of his/her stay
under medical care irrespective of the prognosis of recovery of his condition.
CARE OF PATIENTS AT
END OF LIFE
Principles of dealing with terminal incurable
disease and dying patients: the patient
should:
 The patient himself must be furnished with the appropriate medical information
compared with his/her ability to comprehend the information while in such
condition. Conveyance of such information to the patient must be made by the
physician and in accordance with code of conduct policy
 Furthermore, suitable and appropriate information about the recovery perspective
(prognosis) should be released to one of the persons selected from among the
patient's relatives, so that the death of the patient would not be a surprise for them.
 At some circumstances inpatient can be granted permission to smoke in a
designated area as advised by the attending physician based on the following
criteria:
 If the patient is suffering from a terminal illness and wishes to Smoke and if
there is no benefit would be derived from prohibiting the patient from smoking
CARE OF PATIENTS AT
END OF LIFE
DOES THE PATIENT HAS THE

RIGHT TO REFUSE TREATMENT
IN CASE OF TERMINALLY
ILLNESS?
CARE OF PATIENTS AT
END OF LIFE
WHAT IF THE PATIENT

DOESN’T HAVE THE CAPACITY
TO MAKE DECISION?
CARE OF PATIENTS AT
END OF LIFE
WHAT IF THE PATIENT AND

THE PHYSICIAN’S DECISION
DIFFER FROM EACH OTHER?
CARE OF PATIENTS AT
END OF LIFE
WHAT IF THE PATIENT AND

THE PHYSICIAN’S DECISION
DIFFER FROM EACH OTHER?
CARE OF PATIENTS AT
END OF LIFE
The physician's opinion may

differ from that of the patient,
but in such case, the final
decision remains in the hands
of the patient.
CARE OF PATIENTS AT
END OF LIFE
WHAT IF THE PATIENT

DOESN’T HAVE THE CAPACITY
TO MAKE DECISION?
CARE OF PATIENTS AT
END OF LIFE
DISCONTINUING MEDICAL TREATMENT
 In cases of terminal disease, when treatment by using sophisticated
equipment has proved to be unsuccessful, and that there is no hope of
obtaining any benefit wherefrom, use such equipment for treatment
may be withheld in the first place, or the treatment could be stopped if
these equipment proved to be useless. However, the previously
mentioned principles concerning decision-making should be followed,
and the regulations governing this issue should be strictly adhered. In
such cases, the patient's family must be informed of this decision unless
it were otherwise not possible for substantial reasons.
CARE OF PATIENTS AT
END OF LIFE

 If there were differences of opinion between the patient and his
guardian on one side, and the physician on the other side about the
usage of these equipment, detailed discussion between both parties at
the highest level of responsibility should take place.
CARE OF PATIENTS AT
END OF LIFE

 If no agreement between the two parties on this matter had been
reached, and whereas the general rule states that the patient has the
right to select his physician, the patient could then be transferred to the
medical care of another physician who would accept such task. However,
if this could not be realized, the authority concerned in the hospital
must eventually reach a decision to end this matter.
 Intravenous fluids and potential feeding are of vital necessity for
some patients to survive. Hence, they should not be withheld
from a patient who cannot otherwise be fed normally, regardless
of the nature of his/her disease or its duration.

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Care of Comatose and Vulnerable Patients

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Care of Comatose and

High Risk Services in KNH

Physicians should have a clear understanding of basic ethical concepts

Patients have a right to a “death with

Conditions of Persistent Irreversible Coma:

WHAT IS OUR RESPONSIBILITY?

For terminal/incurable diseases and where

Principles of dealing with terminal incurable

DOES THE PATIENT HAS THE

WHAT IF THE PATIENT

WHAT IF THE PATIENT AND

WHAT IF THE PATIENT AND

The physician's opinion may

WHAT IF THE PATIENT

DISCONTINUING MEDICAL TREATMENT

DISCONTINUING MEDICAL TREATMENT

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