Caring for a Dying Patient
It is very hard to determine when someone is about to die, but when it is predicted, it is important that both the health care professional team, the patient and their family/carers reach an agreement about any clinical decisions.

The five priorities of care, when it is thought that the person may die within the next few hours or days are set out below and explained fully in One chance to get it right published June 2014 by the Leadership Alliance for the Care of Dying People.

  1. Ensure that it is recognised and communicated clearly, a decision is made and actions are taken in accordance with the person’s needs and preferences. All are regularly reviewed and decisions revised accordingly when their condition changes
  2. Regular, effective, sensitive communication between health and care professionals, the dying person and those identified as important to them
  3. The dying person and those identified as important to them are involved in all decisions regarding treatment and care to the extent the dying person wants
  4. Any requests from the families and others identified as important to the dying person are actively explored, respected and met as far as possible
  5. An individual plan of care is produced, which should include food and drink, pain and symptom control, psychological, social and spiritual support, is agreed, co-ordinated and delivered with compassion.

When a person dies in a care/residential home or their own home, when death is expected, it is vital that their GP reviews the person regularly and at least every 14 days. This is both from a care perspective and in order that the GP can issue the Medical Certificate Cause of Death (MCCD) without involving the coroner.

If possible the dying person’s wishes regarding organ and tissue donation should be assessed and discussed with them and their family/carers. Advice and consent is available from the NHS Blood and Transplant (NHSBT) specialist nurse based in Acute Trusts or direct contact via the NHS Organ and Tissue website. In recent years, the law has changed in some countries with the UK and will change for others over the coming years, in respect of consent. More information can be found on the above website.

If the coroner is involved and the death requires an investigation, the coroner may prevent donation as the criminal justice system takes precedence. Although, each case needs to be discussed with the coroner and the NHSBT will facilitate.

Donation of their whole body for medical research can only be agreed by the person before they die and not on their behalf after death.

The dying person and their family/carers may have spiritual, cultural and practical wishes. These should be identified and discussed sensitively in advance of the death, particularly if it involves the immediate release of the body for burial or cremation.

It is also important to find out the persons choice, for the place of death and wherever possible accommodate this choice. Also, if the family/carers wish to be present at the time of death, if not, who should be informed at the time of death. The relevant information will need to be recorded in the patient’s notes and the appropriate health care professional informed.

It is essential that the communication by health care professionals with individuals, family/carers is sensitive, clear and honest to enable timely care to be achieved.

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