6 minute Speed talk Palliative Care Nurses Australia Conference 2020

RAPID Program- Nursing management of noisy respiratory secretions at end of life (70366)

Jane Hunt 1 , Jane Phillips 1 , David Currow 1 , Matthew Doogue 2 , Debra Rowett 3
  1. Palliative Care Clinical Studies Collaborative, IMPACCT, Dept Health University of Technology, Sydney, Ultimo, NSW, Australia
  2. Clinical Pharmacologist Department of Medicine , University of Otago, Christchurch, Canterbury, New Zealand
  3. Discipline Leader Pharmacy, School of Pharmacy and Medical Sciences Director, Drug and Therapeutics Information Service, University of South Australia, Adelaide, South Australia, Australia

Background: The real-world effectiveness of many treatments (medicines and non-pharmacological interventions) has been poorly researched in atypical populations, such as in palliative care where the direct extrapolation of findings from other clinical settings may not inform or worse, misguide clinical advice. Noisy respiratory secretions are often observed in those imminently dying and despite occurring in up to 90% of patients, there is a lack of robust research to guide assessment or management. The cause of noisy respiratory secretions is unknown, but thought to be due to pooling of respiratory secretions as a person becomes weaker, loses consciousness and the ability to cough or swallow.  Family members and carers are often concerned that noisy respiratory secretions are distressing to the patient. Repositioning and oral suctioning are commonly used to reduce noise respiratory secretions. The effectiveness of these interventions has not been studied systematically.

Aims: The RAPID program adds to the evidence base by collecting key clinical outcomes prospectively from a large number of participating sites around the world in a series of studies of specific treatments for specific conditions in atypical populations, particularly palliative care. 

Methods: Nursing Interventions in the palliative care setting will be studied using the RAPID methodology to measure effectiveness of the intervention and to quantify the benefits and harms. This first nursing intervention series will study terminal phase patients with noisy respiratory secretions treated by nurses with repositioning the patient or oral suctioning.

Results:  This first nursing intervention series is collecting data at baseline, T1 (immediately after intervention) and, T2 (when next nursing intervention is needed). The results from the aggregated data will be presented.    

Conclusion: The results of the first series, when completed will look at net benefits and harms of the nursing interventions. 

  1. Consortium Clinical Group. (2016). Management of respiratory secretions in the terminal phase. In Eastern Metropolitan Region Palliative Care Consortium (Ed.). Australia.
  2. Currow DC, Rowett D, Doogue M, To THM, Abernethy AP. (2012) An international initiative to create a collaborative for pharmacovigilance in hospice and palliative care clinical practice. Journal of Palliative Medicine, 15(3):282–6. doi: 10.1089/jpm.2012.9605