Hospital Palliative Care Unit

Guidelines and Suggestions for those Starting a Hospice/Palliative Care Service, 3rd edition

Derek Doyle, OBE, MD

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Hospital Palliative Care Unit

This refers to a bedded unit within a hospital – whether general or specialist, secondary or tertiary. HPCU admits patients whose conditions requires specialist palliative care. After stabilizing the situation, the patient is discharged or transferred to another care setting, if possible.

It differs from a Hospital Palliative Care Team (HPCT) in having beds whereas the HPCT is entirely advisory. Ideally a HPCU should be the base for a HPCT or, at least, the senior members of the Unit can go to advice in other wards. In many hospitals the beds are under the clinical direction of the specialists in the HPCT who use them for patients they have been asked to see in other parts of the hospital, patients who have complex nursing as well as major medical problems, all more easily cared for in the Palliative Care Unit beds. It can, of course, also function when there is no HPCT.

Advantages of a HPCU

Disadvantages of a HPCU

Questions that must be asked before planning a HPCU

Do not resuscitate (DNR) policy

If the hospital has a clear policy, then it must be followed in the HPCU. If not, then one must prepare for the HPCU and presented to senior medical/nursing staff meetings for explanation and approval. There is likely to be vigorous opposition to what many would see as nihilism in the HPCU. ("You can’t just let someone die – it’s our duty to keep them alive by all means known to us.")

Auditing a HPCU

The need for clinical and management audit is as great as, if not more than, in any other palliative care service. It should be given the highest priority; its records kept transparent for all to see and question.

Before the launch of the new service

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