Abstract
‘Primum non nocere’ is one of the most well known moral principles associated with the medical profession. Often, in our bid to maintain and improve quality of life, we neglect to recognise those patients who are in fact nearing the end of theirs. Thus, our aim was to ascertain if we are recognising the ‘dying’ orthopaedic patient and whether key elements of management in accordance with SIGN are being addressed.
All hip-fracture deaths occurring at a District General Hospital over a 4-year period (2012–2015) were included. Paper and electronic notes were used to record patient demographics, days from admission to death, diagnosis of ‘dying’ and discussions regarding DNACPR and ceiling of care. Total numbers of investigations undertaken during the week prior to death were noted.
89 hip-fracture deaths occurred between 2012–2015, of which 57 were female with a mean age at death of 84 years. The number of days post-admission to death was 17.5 (range 0–109). 45 patients had a new DNACPR recorded and 13 were longstanding. 43 patients (48.3%) were diagnosed as dying at a mean of 7.2 days following admission, 31 of whom (72.1%) had ceiling of care discussed. Of this cohort, 32 had futile investigations during their last week of life and astoundingly 10 on the day of death.
Although some effort is being made to recognise the ‘dying’ orthopaedic patient, further work is needed to establish a clear ceiling of care pathway, which maintains and respects patient comfort and dignity during their last days of life.
