Hospice Care Preferences And Symptom Management Note

Patient Identification and Contact Information

Patient Name: Arthur James Pendelton

DOB: 14/05/1942

Medical Record Number: URN-4928174

Primary Care Physician: Dr. Emily Vance (Contact: (07) 3849 2011, e.vance@brisbanegpclinic.com.au)

Hospice Nurse: Sarah Jenkins, NP (Contact: 0412 889 304, s.jenkins@metrohospice.org.au)

Emergency Contact: Margaret Pendelton (Wife), Contact: 0419 223 847

Limits of Care and Assistance Needs

The patient requires full assistance with all ADLs, including two-person transfers, full meal support for thickened fluids, and repositioning every 2 hours to maintain skin integrity. He has explicitly declined IV hydration, enteral feeding tubes, mechanical ventilation, and acute hospital transfers. He prefers to remain at home with a strictly comfort-focused care philosophy.

Advance Directives and Care Preferences

Advance Directive on file, last updated: 12/11/2025. POLST form signed, indicating DNR and DNI status. The patient requests sublingual or subcutaneous analgesia titrated to comfort, accepting palliative sedation if refractory dyspnoea or pain occurs. Prefers to die at home in a quiet environment with immediate family present.

Spiritual support: Visits from local Anglican parish priest requested weekly for communion and prayer; Last Rites to be administered when actively dying.

Care Team Roles and Responsibilities

Margaret Pendelton (wife) is the Enduring Power of Attorney and primary medical decision-maker, while his daughter, Claire Pendelton, manages daily medication administration at home. Hospice NP Sarah Jenkins conducts bi-weekly clinical assessments and adjusts the syringe driver as needed, while PCAs attend daily at 08:30 for personal care. Claire Pendelton is designated as the primary point of contact to receive all clinical updates and coordinate information with extended family members.

Symptom and Pain Management Plan

Current pain level: 2/10 at rest, 5/10 on movement as reported by the patient. Medication plan:

• morphine sulfate (Ordine®) 5 mg SL q2h PRN for breakthrough pain or dyspnoea
• clonazepam (Rivotril®) 0.5 mg SL q6h PRN for anxiety or restlessness
• hydromorphone (Dilaudid®) 10 mg / 24 hr via CSCI for baseline pain control; docusate sodium with senna (Coloxyl with Senna®) 2 tablets PO BD
• Non-medication approaches: Repositioning with pressure-relieving pillows, cool fan therapy directed at face for SOB, and gentle massage to lower extremities.

Emergency and Catastrophic Orders

In the event of rapid decline, administer pre-prepared comfort medications

• midazolam (Hypnovel®) 5 mg SC stat and q1h PRN for acute distress or catastrophic haemorrhage
• haloperidol (Serenace®) 2.5 mg SC q4h PRN for severe terminal agitation
• glycopyrronium bromide (Robinul®) 200 mcg SC q4h PRN for excessive respiratory secretions

If unresponsive and in distress, reposition for comfort and ensure family presence. No hospital transfers or resuscitative measures per patient’s directive.

Family and Caregiver Communication Plan

18/03/2026. Margaret Pendelton (Wife) and Claire Pendelton (Daughter) informed of the current care plan and emergency protocols. Claire Pendelton to receive routine clinical updates every 48 hours via telephone call. If significant changes occur, family will be notified immediately via phone regardless of the hour.

Legal and Compliance Documentation

Signed DNR order on file – dated 12/11/2025.

Power of attorney assigned to Margaret Pendelton, confirmed by legal documentation.

Insurance: Medicare Australia and Bupa Gold Hospital Cover (Palliative Care at Home benefit active)

All documents reviewed and compliant with state hospice regulations. Next review scheduled for 01/04/2026.