End-Stage Stroke & Coma:
Guidelines for End-Stage Stroke, Coma & Related Disorders

CORE INDICATORS:

• In the physician’s clinical judgment, the patient has a terminal condition of 6 months or less if the disease follows its usual course.
• Documentation of End Stage Disease is present.
• The patient/family is informed of the life-limiting condition and choose palliative care. Recently impaired functional and/or nutritional status.

LIFE-LIMITING CONDITION AS EVIDENCED BY:

• A Palliative Performance Scale of < 40; mainly in bed, mostly requiring assistance with self-care.
• One of the following MUST be present and documented in Medical Record:
  • Weight loss > 10% during the previous 6 months.
  • Weight loss > 7.5% in previous 3 months.
  • Current history of pulmonary aspiration without effective response to speech language pathology interventions.
  • Serum Albumin < 2.5 gm/dl.
  • Calorie counts documenting inadequate caloric/fluid intake.

HOW WE HELP — END-STAGE STROKE & COMA:

• Comfort Care and pain control for those in persistent vegetative state.
• Management of feeding tubes as requested by familyor patient if dysphagia is a concern.
• Pain relief related to muscle contractures, constipation, bed sores, and infections.
• Support & education for family and patient as treatments are withdrawn.
• Support for caregivers regarding neurological changes.
• Spiritual care for family and patient as needed.