Assessment of symptom control in dying patients provided with Integrated Care System in the Palliative Care Unit

A retrospective analysis of the previous care results contained in the Integrated Care Pathway documentation and ways of symptomatic treatment contained in the Indywidualna Karta Zleceń was carried out in 36 patients dying in the palliative care unit. In 24 patients (66.6%) most “irrelevant drugs” from the point of view of the current symptom control, mainly those applied in concomitant diseases, were suspended. Significant reduction was observed in the average number of drugs used after providing the patients with care standard for the dying. Diagnostic procedures, rehabilitation treatment and antidecubital standard were suspended in all the patients examined. Routine medical observation and life parameters measurement were substantially limited. Artificial intravenous and subcutaneous hydration was continued in 22 (61.1%) patients, which was not accompanied by complications and decreased comfort of dying. Most of the dying had their symptoms (death rattle, pain, dyspnea, amentia) continuously controlled with the use of “relevant” drugs, such as morphine, tramadol, dexamethazone, midazolam, hyoscine butylbromide, levomepromazine ond haloperidol, applied subcutaneously by continuous infusion or as single doses on demand. In most patients the aims planned in respect to pain, dyspnea and amentia control were reached; only in some patients, after antimuscarinic drug application, the death rattle control was full. The present research has demonstrated that the Integrated Care System documentation is effective not only in the process of monitoring current care, but also in the evaluation of the results of the care standard for the dying in a palliative care unit.