Care in the last hours and days of life

Care in the last hours and days of life is a vital part of medical practice and has recently been highlighted in the media following concerns over the use of the Liverpool Care Pathway for the Dying Patient and the subsequent review by Baroness Neuberger. Ensuring a dignified death for patients with appropriate support for carers is a core activity of all healthcare professionals. Once it has been recognized that a patient may be dying, it is important that pain and other symptoms are managed appropriately. All medication that needs to be continued should be converted to the subcutaneous route when administration via the oral route is no longer possible. As-required medication should be prescribed for the key symptoms that occur in dying patients, such as pain, agitation, increased respiratory tract secretions, dyspnoea and nausea and vomiting. The appropriateness of ongoing investigations and interventions, including antibiotics and blood tests, should be considered. Appropriate communication with the patient and their family is key, to ensure both that the patient's psychological and spiritual needs are met and that the family is aware that the patient is dying.