The Dying Patient & Management Liz Penny Ian Fenwick Macmillan GP Facilitators Bradford & Airedale

Poor Care of the Dying – Effects on Patient & Family Patient and family are unaware that death is imminent Patient loses trust in doctor as their condition continues to deteriorate without acknowledgement Patient and relatives perceive disagreement in the team and get conflicting messages regarding the patient’s condition Patient dies with uncontrolled symptoms including pain/agitation leading to a distressing and undignified death

Poor Care of the Dying – Effects on Patient and Family Patient and family feel dissatisfied with the communication which seems not to be appropriate for the patient’s condition At death CPR is inappropriately initiated Cultural and spiritual needs are not met Outcome - complex bereavement issues, formal complaints regarding care, feelings of failure by staff ,

How to recognise that someone is in the near-death stages:

ANTICIPATORY DRUGS HALOPERIDOL MIDAZOLAM HYOSCINE DIAMORPHINE

EXAMPLE INJ HALOPERIDOL 5mg / ml 5 X 1ML amps as dir INJ HYOSCINE BUTYLBROMIDE 20mg / ml 5 x 1ml amps as dir INJ MIDAZOLAM 5mg / ml 5 x 2ml as dir INJ DIAMORPHINE 5mg 5 ( five ) x 5mg ( five milligram ) as dir WATER FOR INJECTION 10 X 10mls amps