DEVELOPMENT SITE ONLY
Please use current guidelines available on the UHNM intranet for patient treatment
Please use current guidelines available on the UHNM intranet for patient treatment
RECOGNITION
- ‘End of life’ (EOL) is last year of life (DH 2008)
- not confined to terminal phase (last days of life)
- Identify patients approaching EOL early to plan appropriate care and treatment
Triggers for EOL
- Ask the surprise question – ‘Would you be surprised if the patient died in the next 6–12 months’?
- Does the patient have general indicators of decline?
- Does the patient have specific clinical indicators?
MANAGEMENT
1 year-advancing disease
Actions required
- Contact GP to update and recommend addition to Gold standards framework GSF register
- every GP practice has a GSF register of EOL patients to enable community teams to identify, monitor and plan the care of these patients
- Refer to district nurses
Also consider
- Referral to community palliative care service
- Community palliative care services provide
- holistic assessment of patients at home
- symptom management
- psychological support
- ReSPECT form containing
- resuscitation status
- treatment escalation/limitation plan
- wishes and preferences of patient
- Recommend a DS1500
- the DS1500 is a short medical report for patients with a life expectancy under 6 months
- it supports them to claim rapid access to financial benefits
- these reports are most often completed by the patient’s GP or specialist nurse
6 months-increasing decline
Actions required
- Contact GP to confirm patient on GSF register
- Refer to community palliative care service
- Refer to district nurses
- ReSPECT form containing
- resuscitation status
- treatment escalation/limitation plan
- wishes and preferences of patient
- Review unnecessary medication
- Utilise palliative discharge pathway where necessary
- Recommend a DS1500
Last days of life
Actions required
- Follow last days of life guideline
First days after death
Actions required
- Prompt verification of death
- Carry out personal care after death
- Allow adequate time to support family and carers
- Provide Trust bereavement booklet
- Refer to local bereavement support if needed
- Inform bereavement services