Practice Guidelines

Care of adults in the last days of life: summary of NICE guidance

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6631 (Published 16 December 2015) Cite this as: BMJ 2015;351:h6631
  1. Joshua Ruegger, research fellow1,
  2. Sarah Hodgkinson, senior research fellow1,
  3. Antonia Field-Smith, specialist clinical trainee in palliative medicine2,
  4. Sam H Ahmedzai, emeritus professor of supportive care3
  5. On behalf of the guideline committee
  1. 1National Clinical Guidelines Centre, Royal College of Physicians, London NW1 4LE, UK
  2. 2Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
  3. 3Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
  1. Correspondence to: S H Ahmedzais.ahmedzai{at}sheffield.ac.uk

What you need to know

  • Seek support from more experienced staff, including those in palliative care services, if you are unclear about any aspect of care of the dying adult, including the recognition of dying and symptom management

  • Assess for and treat any reversible causes of distressing symptoms or signs in people in the last few days of life—for example, uncontrolled pain or dehydration causing agitation

  • Regularly review the care plan (usually daily), discuss any changes with the dying person and those important to the person; make clear documentation in the medical notes

In 2013, the UK Department of Health called for the abolition of the Liverpool care pathway, which was designed to bring a standard of care for the dying from the hospice sector into other settings. This move was provoked by an independent review,1 which showed that the pathway had been misused and misinterpreted as a tick box exercise. It called for individualised care plans and better staff training in all aspects of end of life care.1 Care of dying people should be based on evidence and must be tailored to individual needs and wishes, rather than being protocol driven. This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE). 2

What’s new in this guidance?

  • Guidance on recognition of dying, with the uncertainty around this, and encouragement of open communication and shared decision making

  • Maintaining hydration (including oral care) as a priority, and offering fluids up until the end of life, regardless of the care setting

  • Emphasis on individualised prescribing for current and anticipated symptoms, avoiding undue sedation or other side effects

Recommendations

NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the committee’s experience and opinion of what constitutes good practice. …

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