End of life care and withdrawal of NIV
After the withdrawal of NIV
The death of someone can be a difficult time not just for his or her loved ones but also for healthcare professionals involved in the care.
All professionals involved in the withdrawal of non-invasive ventilation (NIV) should make appropriate documentation of
the decision-making process
a summary of the medication and other strategies for symptom management
who did what
patient related outcomes
family related outcomes
the time of death
The death certificate must be completed by a doctor who has cared for the patient in their last illness and who has seen then within the last 14 days. Therefore, if the patient has NIV withdrawn at home, either the doctor who was present should complete the certificate or the care plan must make sure that the general practitioner has visited the patient within the 14 day timeframe.
Family members of the patient will need adequate support following the death of the patient and opportunities to discuss the withdrawal process with the professionals involved. Therefore, palliative care services should be involved early in the patient’s care.
The coordinator should ensure that there is a plan in place detailing who will provide support and what type of support the family members will receive following the death of the patient. This will depend on the individual family members but could include a telephone call from one of the senior professionals involved in the days and weeks following the patient’s death and signposting them to support organisations such as MND Connect and MND Scotland.
It is important that the person leading the withdrawal considers the support needs of healthcare professionals involved in the withdrawal after the patient’s death. Members of the multidisciplinary team may need a time to debrief about the events to make sure there are no doubts about ethics and legality. Those involved should also wish to reflect on the outcomes of what went well and what could be improved. Services may benefit from having an in-house psychologist to provide additional support.
Good practice points
The coordinator should plan who will provide support for the family members following the death of the patient.
The person leading the withdrawal should consider the support needs of professionals involved in the withdrawal.
The multidisciplinary team may need a time to debrief.
The multidisciplinary team should reflect on outcomes of the withdrawal process.
Psychological services should be available for professionals who need additional support.