[ad_1]
Bertil Axelsson, who is also chief physician and adjunct professor of palliative medicine at Umeå University, believes that the guidelines developed by the National Board of Health and Welfare in early April developed too quickly, without resorting to proper expertise. In one incident, he discovered that the National Board of Health and Welfare did a quick referral round, the night before the response came in.
– Normally, a national council of experts is convened when you come out with a guideline, so that you get an idea of what reality is like, what level of knowledge we have and what we take care of. But none of us who are experts in palliative care were interviewed. Now, the guidelines have not been of much help but have left a great deal of frustration among staff and family alike.
He believes the guidelines “deviated from reality.”
– Just as there is often a lack of oxygen in the wall and drug pumps, saturation meters are often missing.
Such measure blood oxygen saturation, to detect hypoxia in patients. Bertil Axelsson emphasizes that all older people with covid-19 do not need oxygen, but all must be individually evaluated. A saturation meter in the housing could easily make that easier, he says.
– It is a small flexible device to have as a support, an important parameter to decide if a patient should be treated with oxygen. Such a thing might have been a good level to have in the event of a crown outbreak, and it might have been part of a guide.
As reported by DN, the Swedish Health and Care Inspectorate, Ivo, in its ongoing review of elderly care found that assessments of the care needs of the elderly at the beginning of the pandemic in some regions were more general than individual .
– Most importantly, what benefits the individual patient the most is assessed.
Mention that man Then you need to consider whether the patient, if it is, for example, a person with severe dementia, agrees to wear an oxygen mask or a face halter. It also says that “elderly” people who contract a severe covid infection often do not reach the last stage, when shortness of breath often occurs, and when the patient is in the absolute final stages of life, drugs such as opioids they can provide better relief than oxygen.
– But at the margins, I think some “older-older” could have taken advantage of the oxygen.
DN has described how physical doctor visits to nursing homes decreased dramatically in the Stockholm region during the onset of the pandemic: a third of the visits were managed remotely by the two medical companies that were responsible for the largest part of care.
Bertil Axelsson believes that the pandemic has focused on the limited medical assistance provided locally to the most fragile and seriously ill citizens of society.
– In many places, they have received very little support of that kind, especially in Stockholm. There, I and many with me hope that it can finally be an alarm clock for these people to have greater access to medical expertise.
DN has also drawn attention to cases in which elderly people in nursing homes have been prescribed palliative care immediately after a confirmed covid infection, decisions that could also have been made by a doctor over the phone without informing their family members. . It is a procedure that is critical.
– It is not correct to conduct assessments on palliative care in the final stages of life over the phone. This must be done on site and in communication with family and staff.
In an email to DN On May 28, Henrik Brehmer, head of communications for the health company Capio, responsible for medical care in almost half of all nursing homes in the Stockholm region, described that most of the homes are in what it is described as “in the final stages of life”:
“Most of those who move into special housing die there, many already within six months, some after just over a year. Therefore, we believe that it is the end of life and it is unusual for a death in a special dwelling to occur completely unexpectedly. “
According to Bertil Axelsson, there is confusion about the concepts, even among doctors. Instead of palliative care, according to him, it is more correct to say “end of life care” if a person is seriously ill and may not need to be transferred.
– Even in the care of elderly patients with covid-19, the treatment is always curative initially. The time when you know this patient will not survive is usually a few hours or possibly a day or two. Only then is it about palliative care in the final stages of life, he says, adding:
– You cannot know that a human being is dying for something that most people survive until very late in the process. Before that, it should be a curative care.
