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Of the total 21 regions in the country, 16 have failed regarding end-of-life care, shows Ivo’s review of covid care of the elderly in the home.
In several cases, important documentation is missing, and in one region a decision was made on palliative care for everyone who was confirmed to have COVID-19 by sampling.
– It is not a good thing and it is not part of our way of working, says Marga Brisman, Deputy Regional Chief Physician in Västra Götaland.
There are serious shortcomings in the regions’ work to provide care and treatment to the elderly living in nursing homes and affected by covid-19, a national review by the Swedish Health and Care Inspectorate (Ivo) shows that showed up on Tuesday.
In total, one in five patients did not receive an individual medical evaluation, so Ivo assesses that neither region has taken full responsibility for ensuring care and treatment tailored to individual needs.
– The minimum level is too low, even during a pandemic, said Sofia Wallström, CEO of Ivo, during a press conference.
Photo: Anders Wiklund / TT
Sofia Wallström, CEO of Ivo, during a press conference.
16 out of 21 regions failed
Aftonbladet’s review of regional decisions also shows that a total of 16 of the 21 regions also fail to comply with regulations regarding end-of-life care, also called palliative care.
Of the total 21 regions in the country, only Blekinge, Gotland, Jönköping, Kronoberg and Värmland have not received any comment on end-of-life care or so-called breakthrough conversations, which take place during the transition to palliative care.
“By pressure situation”
In the Stockholm Region, for example, Ivo states that in many cases there is little or no information on how or for what reasons decisions about end-of-life care were made, as well as what information was provided and what consultation was made. performed with the patient and their relatives.
According to Ivo, the lack of medical records constitutes a risk to patient safety as the patient’s care cannot be followed.
Photo: Marko Säävälä / TT
Regional Health Development Councilor Ella Bohlin (KD)
However, nurses and physicians in the region state that decisions about end-of-life care have been made by physicians and qualified personnel after individual evaluation and in consultation with family members, but that this has not been documented “due to the pressure situation that occurred during the pandemic. “
– The criticism that emerges shows serious deficiencies, and sadly the review shows that there have been similar deficiencies across the country. It is important that it comes up and is addressed. We ourselves have identified shortcomings in the past and taken action, says Regional Health Development Counselor Ella Bohlin (KD) through her press manager Ofelia Namazova Venneman.
The nurses held break-up conversations
In the Skåne region, too, there has been a lack of information in several cases on how decisions regarding end-of-life care have been made, including for what reasons, which decision-makers have advised on the decisions and in what way informed the patient and their families.
The interviews also reveal ambiguities about whether decisions are made in consultation with other authorized personnel or whether it was the case that the doctors only communicated their decision to the nurse.
Photo: Johan Nilsson / TT
Rasmus Havmöller, regional chief physician in the Skåne region.
On several occasions, nurses have held balancing conversations as it has been difficult to get doctors to do so, Ivo writes.
– These are patients we care for, no matter what stage of life they are in or where they are treated and we take IVO criticism very seriously, says Rasmus Havmöller, regional chief physician in the region in a press release It adds that a number of steps have already been taken to address the shortcomings.
Everyone in the shelter received palliative care
Also in the Sörmland Region, in many cases there was a lack of information about who made the decision and about the talks about the breaking point.
An interview with the nurse revealed that decisions about palliative care were made for everyone in the facility, regardless of the underlying illness in the early stage of the pandemic, and that the nurses weren’t sure who made the decision, but said it was. the doctor who informed them.
In another interview with the physicians responsible for the patients, it also appears that some physicians did not have time for balance conversations when he was at his worst, but that nurses had to conduct them multiple times and that the division of responsibilities was unclear.
– We have just received the decision and we do not have access to the information on which IVO bases its criticism. Therefore, we are currently unable to comment on what is being addressed in detail, but of course we will follow up and take the necessary action, says Marie Bennermo, head of the patient safety unit in the region.
“Definitely not good”
Even in several cases in the Västra Götaland region, doctors, in consultation with a nurse or other authorized personnel, have not made a decision about end-of-life care after an individual assessment.
It is also unclear whether break-up conversations have taken place in some cases and whether a nurse has participated in the decision to initiate palliative care or whether the doctor has taken it himself, writes Ivo.
In the interviews, it was also stated that, in some cases, breakthrough conversations were held in relation to the annual screening of the elderly, and that doctors at the beginning of the pandemic made a decision about palliative care for all who they had been confirmed to have covid-19 by sampling. If or when the patients were declared healthy, the decision was overruled.
Photo: Johan Främst / Bild o Media / Skaraborgs Sjukhu
Marga Brisman, Deputy Regional Physician in Västra Götaland.
There is also information that doctors have prescribed palliative drugs, although the patient was not very ill.
– It is not a good thing and does not include the way we work, says Marga Brisman, deputy regional chief physician with special responsibility for patient safety work, adding that criticism is taken seriously in cases where Ivo has found deficiencies .
Called only when the patient deteriorated
In the Uppsala region, some interviews with doctors responsible for patients and nurses show that palliative care can be initiated by a nurse without a new contact with a doctor, in cases where decisions about palliative care have been previously documented.
In the Västerbotten region, it appears on the medical examination that when the patient became ill, a special new evaluation was not carried out because so little time had elapsed since the evaluation was carried out.
Furthermore, in the interviews it emerged that decisions on palliative care were not anchored with the family members in direct connection with the decision, but rather that the doctor called the family members when the patient deteriorated.
– The report does not show the complete picture of how the care for these patients has worked, nor how we have developed the collaboration with the municipalities of the county, says Brita Winsa, director of health and medical care in the Västerbotten region in a press release .
Photo: Pontus Lundahl / TT
Stock Photography.
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