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PRINCIPLES
OF CARE
FOR DYING PATIENTS
Identify
Deterioration in
patient’s condition
suggests the patient is
actively dying i.e. has
the potential to die in
hours or short days
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1. Exclude reversible causes e.g. opioid
toxicity, oversedation, renal failure,
infection, hypercalcaemia.
2. Is specialist opinion needed from
consultant with experience in patient’s
condition?
3. Is there an advance care plan and/or
advance decision to refuse treatment?
UNDERTAKE MULTIDISCIPLINARY TEAM
ASSESSMENT
AND SHAPE INDIVIDUAL CARE PLAN
COMMUNICATION
Communicate
Where the senior responsible clinician has identified that a patient under
their care is actively dying or has the potential to be dying soon, they must
discuss the agreed care plan (see over for guidance) with the patient /
patient’s family to clarify and explain:
1. The recognition of dying or the potential for dying
2. The rationale for this, and
3. Respond to the patient/family’s questions/concerns
Document reason(s) if family contact genuinely impossible (e.g. no family)
Document 24-hour specialist palliative care team(s) contact details
Document
Re-evaluate
DOCUMENTATION
The senior responsible clinician must ensure that the individual care plan and
all conversations are documented clearly in the patient’s medical records
REVIEW & RE-EVALUATION OF CARE &
CLINICAL DECISIONS
AT MINIMUM 4 HOURLY REVIEW AND GIVING OF NURSING CARE
AT MINIMUM DAILY REVIEW & RE-EVALUATION BY THE
RESPONSIBLE MEDICAL TEAM
ELEMENTS OVERLEAF
If unsure that the care plan is appropriate or the patient / family raise
concerns, all staff must ask the senior responsible clinician
Daily Care
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Plan
Review
COMMUNICATE with patient / family to clarify aims of care and update family on a regular basis and following any change
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in management. In particular, consider
explain resuscitation, hydration, sedation, and use of medications
DOCUMENT significant conversations in the notes and ensure contact numbers for key family members
•
This may include preferences around place of care, support needs, and specific issues such as tissue donation.
REVIEW INTERVENTIONS AND MEDICATIONS - focus on comfort and dignity
• Consider and explain interventions based on a balance of benefits and burdens, including prescription of fluids
• Communicate decisions with patient (where possible) and family
MAINTAIN EXCELLENT BASIC CARE - frequent assessment, action and review
• Regular mouth care. Turning for comfort as appropriate
• Encourage and support oral food / hydration as patient is able
• Check bladder and bowel function
• Ensure dignity and compassion in all care
ASSESS SYMPTOMS REGULARLY - frequent assessment, action and review
• Prescribe medications as required for anticipated symptoms e.g. pain, nausea, agitation, respiratory secretions
• Medications may be required via subcutaneous syringe pump if symptomatic/no longer tolerating oral meds
• Advice available from the Palliative Care Team, see also Palliative Care Prescribing guidelines on intranet
IDENTIFY SUPPORT NEEDS OF FAMILY
• Ensure contact numbers and contact preferences updated for key family members
• Explain facilities available e.g. accommodation, parking permits, folding beds if available
• Consider single room for patient if available
IDENTIFY SPIRITUAL NEEDS - for both patient and family
• Document specific actions required
• Refer to chaplaincy as appropriate
CARE AFTER DEATH
• Timely certification of death (often important for bereaved families)
• Family bereavement booklet
• Inform GP and other involved clinicians