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Priorities for care of the dying person—duties and responsibilities of health and care staff

Recognise

  • The possibility that a person may die within the next few days or hours is recognised and communicated clearly, decisions made, and actions taken in accordance with the person's needs and wishes, and these are regularly reviewed and decisions revised accordingly
  • Always consider reversible causes, e.g. infection, dehydration, hypercalcaemia, etc
  • Consider potentially reversible cause if person unexpectedly deteriorates. A doctor must assess if change is potentially reversible or if person is likely to die within a few hours or days
  • If the cause of deterioration is potentially reversible take prompt action to address this, provided this is in accordance with the person's wishes (or best interests if they lack capacity)
  • If likely to die very soon, communicate this clearly and sensitively to the person (if conscious and have not indicated they would not wish to know), family, and those important to the person
  • Take into account the person's views and preferences, and develop and document a plan of care with them and those who are important to them if appropriate
  • Regularly review person to make sure plan of care remains appropriate and respond to change in condition, needs, and preferences

Communicate

  • Sensitive communication takes place between staff and the dying person, and those identified as important to them
  • Remember that open, honest, and sensitive communication is critically important
  • Use clear, understandable, and plain language—verbally and in all other forms of communication
  • If needed, provide additional support to help dying person understand information, communicate their wishes, or make decisions
  • Remember that communication is two-way. Listen to views of person and those important to them, not simply provide information
  • Be sensitive, respectful in pace and tone of communication, and take account of what the dying person and those important to them want—and feel able—to discuss at any particular point in time
  • Check the other person's understanding of information that is being communicated, and document this

Involve

  • The dying person, and those identified as important to them, are involved in decisions about treatment and care to the extent that the dying person wants
  • Involve the dying person to the extent they wish to be:
    • in day to day decisions about food, drink, and personal care
    • in clinical and treatment decisions
  • Find out, and respect, the extent to which individuals wish their families and those important to them to be involved in decision-making
  • Tell the person, and those important to them, the name of the senior doctor who has responsibility for their treatment and care, and the name of the nurse who is leading their care. In addition ensure that should either of these people be away that there is a named deputy
  • Where it is established that the dying person lacks capacity to make a particular decision, that decision or action taken on their behalf must be in their best interests. Involve them as far as possible

Support

  • The needs of families and others identified as important to the dying person are actively explored, respected, and met as far as possible
  • Remember that families and those important to the dying person, including carers, have their own needs which can be overlooked at this time
  • Recognise that they may be physically and emotionally tired, anxious, or fearful
  • Ask about their needs for support or information, and meet these as far as possible
  • Listen to, and acknowledge their needs and wishes even when it is not possible to meet all of them
  • Where a dying person lacks capacity, explain the decision-making process to those people who are supporting the dying person and involve them as much as possible

Plan and do

  • An individual plan of care, which includes food and drink, symptom control, and psychological, social, and spiritual support, is agreed, coordinated, and delivered with compassion
  • Develop an individualised plan of care and treatment to meet the dying person's own needs and wishes, and document this so that consistent information is shared with those involved in the person's care and is available when needed
  • Pay attention to symptom control, including relief of pain and other discomforts
  • Pay attention to the person's physical, emotional, psychological, social, spiritual, cultural, and religious needs
  • Support the person to eat and drink as long as they wish to do so
  • Refer to specialist palliative care if the person and/or situation require this, and ring for advice if unsure about anything

Each individual must have an individual care plan according to their needs. The plan should be discussed openly with the person and those identified as important to them. This plan must be reviewed on a daily basis. If unsure, or the dying person or those important to them raise concerns, a senior clinician must review the person, and the goals and plan of care.

full guideline available from…
NHS England, Fifth Floor Central, Quarry House, Quarry Hill, Leeds, LS2 7UA
www.nhsiq.nhs.uk/media/2483136/pfcdp-leaflet2.pdf

NHS England. Priorities for the care of the dying person—duties and responsibilities of health and care staff.
First included: March 2016.