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Medication focus in new end-of-life guidance

Draft NICE guidance ensures patient’s wishes are heard

Adrian O'Dowd

Wednesday, 29 July 2015

Doctors looking after people with a terminal illness should make sure their patients are fully involved in decisions about medicines for managing symptoms, according to new draft guidance from NICE.

NICE’s draft guideline to support the NHS in providing high quality and compassionate care for people who are dying has been published today.

Around 500,000 people die each year in England and it is estimated that three out of four of these deaths are expected, but recognising when death is imminent can be difficult.

NICE’s draft guideline is intended to help doctors and nurses identify when someone is entering their final few days of life.

It follows the abolition of the Liverpool Care Pathway, a protocol for looking after people at the end of their life. The latter was phased out last year after a government-commissioned review found failings in how the pathway was being implemented.

The new guidance sets out a series of recommendations for the prescribing of medicines if these are needed to manage some of the common symptoms experienced at the end of life.

These include nausea and vomiting; pain; breathlessness; noisy respiratory secretions; and anxiety, agitation and delirium.

The guideline says that people who are dying or those important to them should be fully involved in decisions about medicines for managing symptoms in the last days of life.

It also recommends that healthcare professionals review a person’s medication and stop any medicines that are not providing symptomatic benefit.

The draft guideline also lists signs and symptoms that may suggest a person is nearing death.

Clear communication is a vital part of the guideline and it recommends:

  • establishing the communication needs and expectations of the dying person
  • making sure that appropriate records are kept
  • that a confident and competent healthcare professional discusses the person’s prognosis with them and shares the information with other relevant health and social care professionals.

Shared decision making is crucial as the guideline recommends individualised care plans are created with each dying person, their family and those important to them, and the multidisciplinary team.

It also says that people who are in their last days of life should be encouraged to drink if they wish to and are able to.

Sir Andrew Dillon, NICE chief executive, said: “Recognising when we are close to death and helping us to remain comfortable is difficult for everyone involved.

“The Liverpool Care Pathway was originally devised to help doctors and nurses provide quality end-of-life care. While it helped many to pass away with dignity, it became clear over time that it wasn’t always used in the way it was intended.

“The guideline we are developing will ensure that people who are nearing the end of their lives are treated with respect and receive excellent care.”

Dr Catherine Millington-Sanders, clinical lead for end of life at the RCGP, said: “It is crucial that patients approaching the end of their lives receive high quality and compassionate care that is tailored to their own needs and wishes. This guidance highlights how important it is for people to be involved in having discussions about their care.”

The consultation for the draft guideline is open until 9 September and the final version will be published in December.

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