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Clinical Review

Care of the dying patient: the last hours or days of lifeCommentary: a “good death” is possible in the NHS

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7379.30 (Published 04 January 2003) Cite this as: BMJ 2003;326:30

Data supplement

  • Quotes from NHS cancer plan and national service frameworks, relating to care of dying patients

    "Too many patients still experience distressing symptoms, poor nursing care, poor psychological and social support and inadequate communication from healthcare professionals during the final stages of an illness. This can have a lasting effect on carers and those close to the patient, who often carry the burden of care. The care of all dying patients must improve to the level of the best."

    (Department of Health.The NHS cancer plan: a plan for investment, a plan for reform. London: Stationery Office, 2000:7.21; www.doh.gov.uk/cancer/ )

    "Where recovery is not possible [in stroke], this should be recognised by staff. The care of the patient should be discussed with them as far as possible, and with their carers as appropriate. The principles of palliative care should inform the care plan, with priority being given to supporting the patient to die with dignity, without unnecessary suffering, and in the place of their choice wherever possible."

    (Department of Health. National service framework for older people. London: Stationery Office, 2001:5.23; www.doh.gov.uk/nsf/ )

    "When the underlying aim of treatment is to control symptoms, a palliative approach with help from palliative care specialists can improve a patient’s quality of life."

    Department of Health. National service framework for coronary heart disease. London: Stationery Office, 2000:6.18; www.doh.gov.uk/nsf/ )

  • Posted as supplied by author

    An example of part of the Liverpool Care Pathway for the Dying Patient used for 4 hourly assessment in the hospital setting

    Adapted from the Liverpool Care Pathway for the Dying Patient - Ongoing Care

    Integrated care pathway for the dying patient

    Name: ………………………………

    Unit No: ………………………………………. Date: ………………………………………

    Codes (please enter in columns) A = Achieved V = Variance

    Section 2 Patient problem/focus

    08:00

    12:00

    16:00

    20:00

    24:00

    04:00

    Assessment pain/comfort measures

    		      

    Pain

    Goal: Patient is pain free

    • Verbalised by patient if conscious
    • Pain-free on movement
    • Appears peaceful
    • Move only for comfort
    		      

    Agitation

    Goal: Patient is not agitated

    • Patient does not display signs of delirium, terminal anguish or restlessness (thrasing, plucking, twitching)
    • Exclude retention of urine as cause
    		      

    Respiratory tract secretions

    Goal: Patient’s breathing is not made difficult by respiratory tract secretions

    • Patient will be breathing comfortably
    		      

    Nausea and vomiting

    Goal: Patient does not feel nauseous or vomit

    • Patient verbalises if conscious
    		      

    Other symptoms (eg dyspnoea)

    a) ………………………………………

     

    		      

     

     

     

     

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