Refresh in end of life care guidelines
These new guidelines have been implemented to put the dying person at the heart of decisions regarding their care, to ensure they are supported in their final days in line with their wishes.
Of around 500,000 deaths, 75% are not sudden, but expected.
UK has ranked recently as the best in the world for care, as ever there are areas where care can be made better and more consistent.
The Liverpool Care Pathway (LCP) was previously used to provide good end of life care. However following large criticism and a subsequent government review, they found failings in several areas. These included:
No way of reliably determining whether a person was in the last days of life
Withholding or withdrawing drinking water and essential medicines
Some cases of changes to treatment being carried out without forewarning
The new guideline, developed by NICE, aims to tackle the above and other issues by providing recommendations for the care of a person who is nearing death no matter where they are.
Recognising when a person might be entering the last days of life
It will always be tricky to assetain whether a person is dying, as the ways in which people deteriorate at the end of life will depend on their condition.
To help identify the last days of life, the guideline recommends that healthcare professionals should assess for changes in certain signs and symptoms. These include agitation, deterioration in level of consciousness and increasing fatigue and loss of appetite.
Healthcare professionals should also be aware that these signs and symptoms might suggest that a person is dying, but improvements can occur suggesting that a person may be stabilising.
Those reaching end of life should be assessed for further changes at least every 24 hours, and the person’s care plan should be updated in line with any changes.
Ensure good communication and shared decision-making
It was highlighted that poor communication was often appearing in complaints over care at the end of life.
It claimed healthcare professionals were avoiding open and honest conversations with family members and carers that are vital for them to understand the severity of the situation and the decisions they are facing.
NICE recommends the dying person, and those close to them, should be given honest information about their prognosis, with freedom to talk through fears and anxieties and information about how to contact members of their care team.
Healthcare professionals should participate in decision-making on a person’s end of life care, and the lead healthcare professional should be made responsible.
Supporting people at the end of life to drink if they want to
Among the criticisms found within the LCP, it was found too often that supporting those to drink was being poorly implemented, leading to people becoming dehydrated.
NICE recommends that the dying person should be supported to drink if they wish and are able to.
They should also be advised that whilst giving fluids in this ways may relieve some problems, they could cause others and that, in a person already near death, there is medical uncertainty whether giving assisted hydration prolongs or shortens a person’s life.
An individualised rather than a ‘blanket’ approach to care
Until now we have never had guidelines on how to look after people at the end of life. The main way this guideline differs to the LCP is that it stresses an singular approach rather than a overall method of using the LCP in an unthinking way.
The guideline also expresses that the patient should be assessed each day, and the person should always be taken as an individual person with individual needs.
As health and social care professionals, it should all be that everyone is offering the best care – whether that’s clinical or practical – in order to support people’s experience of a good death.
Death is something that happens to us all and how we are cared for can make a big difference to our final days.