Page 16 - TERMINAL DISCHARGE GUIDELINE FIRST EDITION 2023

Chapter 3
Introduction

Furthermore, the end-of-life patients commonly suffer from physical
symptoms such as delirium, dyspnoea, pain, and respiratory secretions,
not mentioning the emotional and spiritual baggage. Simultaneously, they

also develop dysphagia, hence swallowing oral medication becomes
extremely difficult. Absorption is also impaired when they are very ill or
terminally ill. Therefore, there is a need to administer medications through

other alternative routes such as sublingual or subcutaneous route to
improve quality of life.

Terminal discharge is recognised and practiced internationally. Therefore,
when patients or their loved ones expresses their preferences to be home
and there are no obvious obstacles, it becomes crucial to assess them
and home environment as soon as possible. Once there are no

hindrances, the pivotal aim is to help them discharge home without delay
so they can spend this critical period with their loved ones.

Recognising that Terminal Discharge can be extremely stressful as it
means performing multiple tasks simultaneously within a short period of
time with much urgency, especially in the urban setting where nuclear

families are getting smaller. If the discharge process is prolonged or
delayed, the patient may pass away in the hospital instead.

Therefore, the Palliative Unit in Hospital Kuala Lumpur spearheaded this
Terminal Discharge Guideline to provide a standardised framework to
facilitate terminal discharges for hospitalised patients where their
preferred place of care (PPOC) and preferred place of death (PPOD) is

home.

By developing this guideline, we hope that hospitalised patients in
Hospital Kuala Lumpur who are at the end of their journey with the
preference to pass away at home will be able to do so with adequate skills
and medications to ensure they are comfortable, have relief from

distressing symptoms and have good quality of life.

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TERMINAL DISCHARGE GUIDELINE 2023