Studiu retrospectiv vizând inițierea protocolului de stare terminală în serviciu de îngrijiri paliative Hospice Casa Speranței | [Retrospectiv study related with the developing protocol of end stage in hospice ”Casa Sperantei”]

Abstract

Introduction: The terminal care protocol developed by the Romanian National Palliative Care Association was to be piloted by Hospice Casa Sperantei (HCS), the leading palliative care service in Romania. Staff was concerned about not identifying correctly the moment of initiation of the protocol. Method: A retrospective study was used to assess the application of the protocol in the first 140 patients who died under the HCS care in all the services outpatients, inpatients, and home care in the first 3 months of the protocol implementation. Data were collected from patients’ charts and specific protocol documentation. Result and Discussion: The protocol was applied in 56% of cases with no significant difference between settings. There was a positive correlation between the number of days of care and protocol application (p=0.012). The length of the protocol application ranged from 1 to 12 days with 65% of cases having between 2 and 4 days of application. The main reasons for not applying the protocol were sudden death by a heart attack, hemorrhage, fear of staff applying protocol just based on 2 criteria (this was the requirement in the protocol but staff waited for all 4 criteria to be applicable), and family refusal. These data are comparable to other international studies. Conclusion: The protocol was successfully applied by HCS staff and other sites in Romania are encouraged to use the protocol.