If a patient or family member calls / admitted to hospital with Covid infection.  

🔴Inquire about  goals of care, POLST. Inquire about healthcare wishes and directives. 

🔴If the person cannot make decisions we need to have a discussion with the decision-maker. 

🔴Please try to review medical records.  

🔴Evaluate for decision making capacity. 

🔴Inquire about goals of care : discuss that with the patient and or caregiver or family members or designated power of attorney.

👩🏿‍💻Document the goals of care.

🔴Get a detailed history and inquire about what the patient understand and what’s going on with the patient and then ask them as to how he wants to be treated. If patient is unable to answer you need to talk to the person who has designated power of attorney. 

🔴 Document patient’s most of the comorbidities 

🔴 All pertinent diagnosis 

🔴Prognosticators 

🔴 Each patient needs individualized care. 

🔴Progress : 

A.  No comorbities. 

B.  Mild comorbidities. 

C.  Multiple comorbidities: seriously ill patient.


Group A

    Full treatment without any restriction

 


 

Group B

Mild comorbidities. 

Discuss in detail : about treatment plan, 

Including intubation, resuscitations if needed in future. 



Group C

Multiple comorbidities 

Seriously ill 

Poor SOFA score 

ICU and ventilators may not be beneficial. 

Give them time to think about it. 

And you need to ask as to what the patient or the caregiver or the designated power of attorney wants us to do in case he gets very sick.


👉🏿 The patient with poor prognosis: 

🅾️Poor outcome because patient has severe, multiple  comorbidities 

🟣 Patient is poor candidate for intubation and or resuscitation 

🅾️ Patient wants comfort care and / or supportive care and does not want ICU, does not want resuscitation, does not want intubation. 

🅾️We need to put him on comfort care and or admit to hospice and palliative care. 

🛑 Choose the best possible treatment for the patient. 

🟣 You’re not required to provide unethical, inappropriate, unavailable or treatment which you think is futile. If needed get a second opinion. 

🛑 Patients who belongs to comfort care or hospice and palliative care should be treated with respect and you need to talk to the family members and others involved. 

🔴 Follow CDC infection prevention guidelines to the tee. If patient remains in patient follow the hospital Covid policy. If transfer to Covid facility follow infection control steps. If sent home needs isolation, PPE (personal protective equipment), meticulous infection prevention. Family / care giver / medical personnel should follow the infection prevention. 

🛑 Prevent spread of infection.
🔴Comfort the dying and all involved. 

 

👨‍⚕️ PHYSICIANS:

You can tell them that you wish things would’ve been different. You don’t think that the treatment will provide any benefit to the patient. Using the ventilator and keeping patient in ICU may not be helpful. Reassure that hospice team will not let patient going to die in pain and suffering. Our team is going to make patient as comfortable as possible.

Talk to the patient, family members, designated power of Attorney, friends with respect and tell them that your team will be there to help them. You know that this is a very difficult time we will do everything possible to care for the patient.

Thanks. Send comments to improve this. 

Dr. Kazmi

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2 thoughts on “Goals of care in Covid 19 patients with poor prognosis:

  1. I like the outline overall looks good
    Definitely I would emphasize ongoing communication w family to promote understanding and acceptance of the situation.

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