Determining the best path for Harry

7

Determining the best
path for Harry

Now view two different pathways that can be taken with Harry.
In progressing through each pathway, you can reflect upon the care decisions made, how you would feel if you were involved in this care, and how the care decisions impact upon Harry and his daughter.

Pathway 1

Finish your shift and go home

Pathway 2

Escalate the situation

Start Pathway 1

Pathway 1

Finish your shift and go home

PLAY NARRATIVE

You feel you have done all you can, and the responsibility rests with the
neurosurgical doctors.

Harry is handed over to the night staff, and it is conveyed that the registrar said
to keep everything as it is until the team review Harry in the morning.

You write in the medical file and leave the ward.

In the early hours of the morning, Harry is found pulseless in cardiorespiratory
arrest by the nursing staff, and a Code Blue is called.

The ward staff commence CPR...

...and the Code Blue Team arrive to continue resuscitation
and administer adrenaline.

The nurse in charge is unable to reach Harry’s daughter by phone,...

...and Harry is declared dead approximately 20 minutes later,
when the code blue team decides to “call it”.

PAUSED

PLAY NARRATIVE

You feel you have done all you can, and the responsibility rests with the
neurosurgical doctors.

Harry is handed over to the night staff, and it is conveyed that the registrar said
to keep everything as it is until the team review Harry in the morning.

You write in the medical file and leave the ward.

In the early hours of the morning, Harry is found pulseless in cardiorespiratory
arrest by the nursing staff, and a Code Blue is called.

The ward staff commence CPR...

...and the Code Blue Team arrive to continue resuscitation
and administer adrenaline.

The nurse in charge is unable to reach Harry’s daughter by phone,...

...and Harry is declared dead approximately 20 minutes later,
when the code blue team decides to “call it”.

PAUSED

View transcript of above narrative

You feel you have done all you can, and the responsibility rests with the neurosurgical doctors. Harry is handed over to the night staff, and it is conveyed that the registrar said to keep everything as it is until the team review Harry in the morning. You write in the medical file and leave the ward.

In the early hours of the morning, Harry is found pulseless in cardiorespiratory arrest by the nursing staff, and a Code Blue is called. The ward staff commence CPR and the Code Blue Team arrive to continue resuscitation and administer adrenaline. The nurse in charge is unable to reach Harry’s daughter by phone, and Harry is declared dead approximately 20 minutes later, when the code blue team decides to “call it”.

Which of these best represents your reactions to this outcome?

Now explore the alternative pathway to see what happens with Harry

Start Pathway 2

Pathway 2

Escalate the situation.

PLAY NARRATIVE

You decide to ask someone else to assess the situation and work out what
is best for Harry.

You call the after hour’s senior medical registrar covering the wards and
explain the situation from your perspective.

The medical registrar attends the ward, assesses Harry, then calls the
neurosurgical registrar

and has further discussions about how best to look after Harry at this juncture.

On the basis of this, the neurosurgical registrar agrees with a palliative approach.

A phone call is then made to Harry’s daughter to discuss his deterioration,
and a focus on quality of life and comfort...

...given his previously expressed wish to “call it quits” if “things are looking bad”.

Harry’s daughter agrees with this palliative approach.

Lines are removed and unnecessary medication is ceased.

As needed pain relief and anxiolytics are charted, along with other end of
life medications for comfort measures.

Harry dies peacefully in the early hours of the morning, with his daughter
in attendance.

PAUSED

PLAY NARRATIVE

You decide to ask someone else to assess the situation and work out what
is best for Harry.

You call the after hour’s senior medical registrar covering the wards and
explain the situation from your perspective.

The medical registrar attends the ward, assesses Harry, then calls the
neurosurgical registrar

and has further discussions about how best to look after Harry at this juncture.

On the basis of this, the neurosurgical registrar agrees with a palliative approach.

A phone call is then made to Harry’s daughter to discuss his deterioration,
and a focus on quality of life and comfort...

...given his previously expressed wish to “call it quits” if “things are looking bad”.

Harry’s daughter agrees with this palliative approach.

Lines are removed and unnecessary medication is ceased.

As needed pain relief and anxiolytics are charted, along with other end of
life medications for comfort measures.

Harry dies peacefully in the early hours of the morning, with his daughter
in attendance.

PAUSED

View transcript of above narrative

You decide to ask someone else to assess the situation and consider what is best for Harry. You call the after hour’s senior medical registrar covering the wards and explain the situation from your perspective. The medical registrar attends the ward, assesses Harry, then calls the neurosurgical registrar and has further discussions about how best to look after Harry at this juncture. On the basis of this, the neurosurgical registrar agrees with a palliative approach.

A phone call is then made to Harry’s daughter to discuss his deterioration, and a focus on quality of life and comfort given his previously expressed wish to “call it quits” if “things are looking bad”. Harry’s daughter agrees with this palliative approach. Lines are removed and unnecessary medication is ceased. As needed pain relief and anxiolytics are charted, along with other end of life medications for comfort measures. Harry dies peacefully in the early hours of the morning, with his daughter in attendance.

In the following three video’s, experts explore the healthcare professional’s responsibilities, ethical considerations, and options regarding how to proceed, where staff believe that patients might be harmed by the healthcare decisions being made.

Prof Ian Kerridge

“What ethical responsibilities do healthcare professionals have if they believe patients are being harmed?”

Prof Ian Kerridge

“Where healthcare staff have concerns about patients being harmed, what should they do?”

Dr Jan Maree Davis

“What should healthcare staff do if they think a shift to the palliative approach is needed for a patient?”

HARRY'S CONDITION DETERIORATES

FINAL REFLECTIONS