Care planning and regular review

Care should be actively aimed at achieving a good and dignified death. Regular planned review and documentation of the care plan will make sure the best care is given as the patient’s condition deteriorates, stabilises or improves.

• Food and drinks: support the patient to take these as long as they are able and want to.
• Essential comfort care: usually includes an alternating pressure mattress to minimise avoidable skin breakdown, repositioning for comfort, eye, mouth, bladder and bowel care.
• Medication:
• stop any treatments not consistent with the agreed goals of care
• continue medications consistent with goals of care
• consider the need for any immediate additional medication
• make sure anticipatory medications for common symptoms are available and prescribed for as required use
• ensure most appropriate route for each medication
• consider the need for a subcutaneous (SC) infusion of medication via a syringe pump.
• Investigations or clinical interventions are unlikely to be of benefit at this stage. Make a clear record of any interventions that are not appropriate.
• Assisted hydration or nutrition: consider the benefits and risks and review plan regularly.
• Over-hydration can contribute to distressing respiratory secretions. However, where indicated, a slow SC fluid infusion may be considered on an individual basis (refer to Subcutaneous fluids guideline).
• Consider emotional, spiritual, religious, cultural, legal and family needs, including those of children and people with cognitive impairment or learning disability.
• Bereavement: identify those at increased risk of complicated grief and seek additional support.

note: syringe pump and syringe driver are both relevant terms