End of life care

The care must be individualised, and take account of the person’s needs and wishes, and those of people who are close to them. This page provides resources and information to help staff and healthcare professionals in caring for a dying person.

If staff have any doubts about what care to give, or how to give it, they should always seek advice from a senior colleague or someone in a relevant specialty, including specialist palliative care.

The resources here include local and national guidance and documents, and also signposting to documentation to support planning, communicating and delivering care for the dying person.

Local guidance

• ‘Care of the dying patient – guidance for professionals’ – this is a brief summary written by the trust’s specialist palliative care team and relevant to professionals working in all settings. It includes prompts drawn from the publication ‘Priorities of care for the dying person’. You should make sure this is easy to access by you and your colleagues wherever you are working as a reminder of key aspects of care planning, communication and delivery.
• ‘Top tips for difficult conversations’ – suggestions on how to express some of the difficult issues which need to be discussed when explaining and agreeing care.
• ‘Palliative and end of life care guidelines’ – symptom control booklet with clear guidance on drugs, doses and other information to manage symptoms.

Local documentation

The nursing core care plan for the dying person is available to staff on the trust’s intranet site under the nursing care plans section. The medical team/senior clinician must record a summary of the decisions made and communicate when it is recognised that a patient is being cared for in the last days of their life.

This medical/senior clinician care summary must be recorded in the healthcare record. Two frameworks are available to guide staff:

• Medical care summary for the dying adult (devised in South Tees)
• Senior clinician initial assessment (part of a northern regional document)

The medical/senior clinician summary may be written on one of these (you do not need both) or recorded in free text in the notes provided it includes all the aspects of care and communication highlighted in the guidance document.

The medical care summary/senior clinician assessment should be written by, or at the very least countersigned by, the senior clinician responsible for the patient’s care.

National guidance

• ‘Priorities of care for the dying person’ – also published by the Leadership Alliance for the Care of Dying People (LACDP) with detail on the five priorities of care for the dying. This summarises the current responsibilities expected to be delivered by all health and care professionals who care for the dying, and must be read. Its requirements underpin all new supporting documentation and guidance provided to assist in delivering this care, and the audit standards which monitor the care provided.
• ‘One chance to get it right’ – a publication from the Leadership Alliance for the Care of Dying People (LACDP) highlighting the need for a renewed emphasis on support for the dying and those who care for them.
• ‘Treatment and care towards the end of life’ – published by the General Medical Council (GMC) in 2010, this is a clear guide to what is expected of doctors, including support on making decisions ethically and legally.
• ‘Decisions relating to cardiopulmonary resuscitation’ – is 2014 updated guidance from the British Medical Association, Resuscitation Council (UK) and the Royal College of Nursing.
• ‘End of Life Care Quality Standards’ – published by NICE in 2011, this sets out the high level standards which all health and social care providers, commissioners and professionals should be working to achieve.

We are committed to a constant process of quality improvement. If anyone has had a poor experience, we would like to hear about it in order that we can learn and take appropriate measures.