Last days and hours of life what to consider:

This may be the time that plans can be actioned such as ACP, individualised care planning, Unified Do Not Attempt Cardiopulmonary Resuscitation (uDNACPR) and anticipatory clinical management planning as described in ACP. 

When it is recognised that the patient may be entering their final days of life, communication is key when coordinating care.  Ensure that all reversible causes of deterioration have been explored, a decision by the most senior clinician involved in the patient care, usually the GP or a consultant, should be made that the patient is dying and this should be sensitively communicated to the patient where possible and those important to them. 

The North West Model for Life Limiting conditions should be followed and the patients colour code changed to red days NHS England — North West » North West Model for Life Limiting Conditions. This will help teams prioritise care. 

How to recognise that a patient is dying

Provide practical support and information about what to expect when someone is dying and ensure they have contact numbers for the teams caring for the patient.  Involve the patient and those important to them in planning care and ensure information is shared.  Commence an individualised plan of care for the last days of life so that everyone involved in the patient’s care can see who is doing what, where and when.  All care and communication should be documented in the patients record. One Chance to Get It Right

There should be a conversation with those people important to your patient about what should happen after they die.  Things to include should be symptoms of the dying process such as breathing changes – see the 'Information for Families, Friends and Carers of Dying People' leaflet.  It should be explained to them that there is no rush, this was to be expected and that they can spend some time with their loved one after they have died.  They should be advised to contact their community nursing team and their GP. 

Conversations may be difficult at this time and you may feel you need support from more senior colleagues.  This is ok; recognising your limitations, confidence and competence is important.  These conversations become easier with experience. 

There may be symptoms that require careful monitoring and review.  The following document may support decisions about anticipatory medications at the end of life.  Palliative Care Clinical Practice Summary 2nd edition 2021

You will need to complete Mersey Care documents available for individualised care planning:

  • EMIS -  all areas
  • Care and Communication Record (CCR) -  Knowsley
  • Individualised Plan of Care (IPC)  - Southport, Formby and North Sefton
  • Individualised Care Plans EMIS  - Liverpool and South Sefton
  • EOLC medication administration documents.