The Priorities of Care (2014) provides an individualised focus to the care of patient’s recognised as dying in hours and days. The priorities approach has been implemented at ASPH. Health care professionals use these priorities to ensure individualised care to dying patients. The fifth priority of care is ‘Plan and Do’. ‘Plan and Do’ requires staff to proactively develop a care plan individualised for each dying person. One section in ‘Plan and Do’ is the attention to detail of current symptoms and anticipated symptoms. As part of this approach, it is essential to ensure safe and effective management of symptoms in the last hours or days of life. Non-pharmacological methods of symptom management are an important part of high-quality care at the end of life, for example, re-positioning to manage pain1. However, this is not addressed in this guideline. This guideline focuses on the pharmacological management of common symptoms in the last hours/days of life and includes general recommendations for non-specialists prescribing medicines to manage these symptoms.
A recognised approach to ensure this for all dying adult patients is the practice of anticipatory prescribing. Anticipatory prescribing is designed to enable prompt symptom relief at whatever time the patient develops distressing symptoms, and is based on the premise that, although each patient is an individual with individual needs, many acute events during the palliative period can be predicted and management measures put in place in advance.
These guidelines are relevant to all staff involved in caring for the dying patient, in particular those involved in the prescribing and administration of medication. The guidelines are relevant to: All Doctors, Registered Nurses, Non-Medical Prescribers, Supportive and Palliative Care Team and Pharmacy (not an exhaustive list). These guidelines must be used in conjunction with the individualised care planning of adult patient in the last hours and days of life (Priorities of Care) policy and documentation.
The purpose of this guideline is to outline how to safely prescribe medication for the common anticipated symptoms that an adult patient may experience in the last hours /days of life. These guidelines support the ‘Plan and Do’ section of the guideline for the individualised care planning of adult patient in the last hours and days of life (Priorities of Care). The two guidelines should be used together to deliver excellent individualised care for all adult patients dying in hours or days across Ashford and St Peter’s NHS Trust.
|Compiled by:||Dr Clare Smith, Consultant in Palliative Medicine|
|Ratified by:||Drugs and Therapeutics Committee, EoLC steering group|
|Date Ratified:||March 2017|
|Date Issued:||Feb 2018|
|Review Date:||March 2019|
|Target Audience:||All clinical staff|
|Contact name:||Dr Clare Smith, Consultant in Palliative Medicine|