Care in the Final Days of Life
The following advice applies to patients in the last moments, hours or days of life.
As with all decisions, the guidance from the RCS’s Consent: Supported Decision Making should be followed when deciding which treatments to implement, however recommendations are made to
Identify and document when patients may be in the last days of life. Indications that patients may be entering the last days of life are;
- Agitation, Cheyne-Stoke’s breathing, deterioration in consciousness, mottled skin, noisy respiratory secretions, progressive weight loss
- Fatigue and loss of appetite
- Changes in communication, mobility, performance status, social withdrawal
Where you have determined that the patient is dying, you should sensitively communicate this status to both the patient and, with consent, their family.
- Limit investigations that are unlikely to affect care unless there is a clinical need to do so.
- Monitor the patient for changes to their condition at least every 24 hours and update their care plan.
- Communicate with patients appropriately.
- Ensure there is a named healthcare professional responsible for the care of the patient.
- Ensure care is individualised.
- Maintain hydration where possible (see below).
- Provide appropriate non-pharmacological measures for comfort where possible e.g. positioning to relieve pain.
- Review medications to stop any that are not providing symptomatic benefit or that may cause harm.
- Consider alternative routes for administration of medication if an oral route is not being tolerated, e.g. subcutaneously or intravenous using a syringe pump where necessary.
- For symptoms such as pain, breathlessness, nausea and vomiting, anxiety, delirium and agitation review and consider treatment of reversible causes. Attempt non-pharmacological interventions first, and treat pharmacologically where persistent.
- If distressing to the patient, noisy rattling breathing can be treated pharmacologically and should be monitored. However, the harms and benefits of these therapies should be weighed up, as the anticholinergic agents used in this case can cause excessive dry mouth and other side effects, about which the patient is unable to complain.
- It is often appropriate to prescribe anticipatory medicines to ensure there is no delay in administering medicines to provide maximum comfort for the patient when needed.
This guidance is based on the NICE guideline Care of Dying Adults in the Last Days of Life.