Electronic Proactive Assessment and Information Guide for End of Life (EPaige)

Last Days of Life

Actions for Professional Consideration

Recognise

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.
  • Use of Electronic Palliative Care Coordination Systems’ (EPaCCS) will help with communication across care settings and between in hours and out of hours services
  • As a minimum requirement If the person is dying in their usual place of residence and EPaCCS is not available, Special Notes should be communicated to the Out of Hours and Ambulance Services so that the persons death is treated as expected

Involve

  • The dying person, and those identified as important to them, are involved in decisions about treatment and care e.g. DNACPR and withdrawal of treatment, 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 and 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, who is the senior doctor who has responsibility for their treatment and care, and who is the nurse leading their care.
  • 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
  • Consideration should be made regarding the involvement of appropriate local Palliative and End of Life Care Services that may offer varied forms of support to the person and those important to them

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