End of Life Care Clinical Pathway — Emergency Department
End of Life Care Clinical Pathway — Emergency Department
Dying Child
Patients with Do Not Attempt Resuscitation Orders (DNAR)
- Proceed with resuscitation unless DNAR present with parent/guardian/patient consent.
- Parent/guardian/patient can override prior DNAR at any time.
- POLST Forms Policy
- If proceeding with DNAR, enter order in EPIC (DNAR Job Aid) and note:
- DNAR notes from the palliative care team or any other team can be viewed in the notes section. Recommendation to use the search tool to find notes.
- POLST forms can be found under the media tab.
- For patients followed by palliative care, please consult PACT for questions: 1-888-385-7228.
Family Presence during Resuscitation
| Physician | Designate attending physician or fellow to speak to family members when possible |
|---|---|
| Social Work | Assist in obtaining history Contact family members |
| Chaplain | Assess need for spiritual support |
| Child Life | Partner with Social Work to support siblings |
Termination of Resuscitation
- There are no absolute predictors/criteria for resuscitation termination.
- The Attending physician is responsible for this decision which includes the input of the resuscitation team members.
- Factors to consider:
- Witnessed vs. unwitnessed arrest
- Interval from arrest to arrival of trained personnel
- Interval from on-scene to hospital arrival
- Length of CPR before return of spontaneous circulation
- First and subsequent rhythm
- Number of doses of epinephrine required
- Age of patient
- Comorbid conditions
- Possible ingestion
- Hypothermia