Palliative and End of Life Care

Personalised Care Plans for Dying Patients

The ‘Caring for Dying Patients: Personalised Plan of Care’ is a paper document that should be used for the care of all inpatients who are recognised to be in their last days of life (excluding those on critical care).

Please be proactive in letting your consultant or registrar know about any patient who you are concerned may be dying.

Once dying is recognised, please ensure that the ‘Caring for Dying Patients: Personalised Plan of Care’ is used for all further documentation of the patient’s care. It is intended to support you and your colleagues in creating a personalised plan for the patient’s EoLC which establishes and respects what matters most to them and those important to them.  There are 3 main sections, each with guidance followed by space for documentation: initial review, daily review, and care after death.  Nursing staff have an equivalent care plan for dying patients (additional needs 12b/c) that they use on the electronic system Lorenzo.

A training video on how to use the document and how to care for dying patients is available via PALMS – click here to watch.

Further guidance and resources can be found on the EoLC intranet page – click here.

Palliative Care Prescribing

Anticipatory medications as an order set can be found on Lorenzo. Tick ‘order sets’ and search for ‘palliative’. There are two options depending on the patient’s eGFR. Once the order set is selected you will need to click each medication in turn to prescribe.

For guidance on palliative care prescribing, please refer to the following guidelines which can only be accessed from a Trust computer (under Clinical Guidelines):

Guidance for Medicines Management of Hospital Patients in the Last Few Days of Life - http://nww.sth.nhs.uk/STHcontDocs/STH_CGP/PalliativeCare/LDOLmedicinesManagement_Hospital.pdf

The Adult Sheffield Palliative Care Formulary - http://nww.sth.nhs.uk/STHcontDocs/STH_CGP/PalliativeCare/SheffieldPalliativeCareFormulary.pdf

In complex patients or those where commonly prescribed medications are failing to alleviate symptoms, referral to the palliative care team can be made via ICE. This referral can also be made by the nursing staff. The palliative care team can also assist in calculating appropriate doses and obtaining the equipment for subcutaneous syringe drivers.