Caring for people in the last days and hours of life - National Statement

Annex A Caring for People in the Last Days and Hours of Life

Caring for People in Last Days & Hours of Life - Driver Diagram

• NHSScotland is committed to provision of consistently high quality end of life care for all that reflects key principles and ensures careful consideration of the approach to be taken to address key issues of nutrition, hydration, recognition of imminent death and communication.
• The name of the lead clinician should be clear to everyone at all times

All actions within the national guidance are focused on delivery of an overall aim where all people's care needs are identified and effectively addressed through responsive and holistic care planning. The statement of this aim will allow local teams to review care and determine the extent to which this is being delivered. Teams will want to set 'how much by when' aims statements and outline the local measures that are in place to identify if changes locally are resulting in the improvements desired. The proposed primary drivers can be used to identify tests of change and improvement actions that will contribute to learning about how best to consistently deliver the aim for everyone during the last days and hours of their lives.

Staff may find it helpful to refer to the summary below, which outlines the way in which the principles underpinning the guidance are supported by some key actions, which if taken consistently, will contribute to high quality care.

PRINCIPLES

Principle 1: Informative, timely and sensitive communication is an essential component of each individual person's care

• Information provision
• Elicit and clarify expectations
• Discuss wishes & care goals/plan
• Support team communication

Principle 2: Significant decisions about a person's care, including diagnosing dying, are made on the basis of multi-disciplinary discussion

• Team recognition of last days or hours of life
• Ensure appropriate interventions consistent with care goals/plan
• Ensure care provided in desired setting
• Record decisions and communicate these

Principle 3: Each individual person's physical, psychological, social and spiritual needs are recognised and addressed as far as is possible

• Recognise, anticipate and meet care needs in all domains
• Assess, review and plan care in all domains - daily review
• Include assessment of key symptoms
• Consider need for specialist palliative care advice
• Ensure decisions are documented
• Explain decisions to family

Principle 4: Consideration is given to the wellbeing of relatives or carers attending the person.

• Explanation, preparation and support for death - listening to worries and fears
• Ongoing support, practical advice and information essential after a death
• Explain content of death certificate and provide chance to ask questions
• Provide information about support to cope with bereavement

APPROACH TO BE TAKEN

Nutrition and Hydration

• Support people to eat and/or drink
• Ensure good mouth care at all times
• Decisions must always be communicated and explained to family and carers

Recognising Uncertainty

• Ensure open discussion of uncertainty
• Consider risks and make sure on-going monitoring and team discussion takes place

Communication

• Remember to focus on condition, expectations of change, wishes and agreed care goals
• Discussion about signs of imminent death and enabling preferences re presence at time of death
• Regular communication within and between teams supports continuity and ensures information is accurate for people and their family