Last Days of Life

The type of care and services utilised by dying patients is being increasingly examined, especially in relation to their care in the last days of life.

Evidence from the NSW Between the Flags program, as well as from incident reports and Root Cause Analyses, describes the failure of treating teams to identify patients at risk of dying, and then develop & document appropriate treatment plans and communicate appropriately with patients and carers.

Scope and Purpose of Toolkit

To improve and support the care of the dying patient, the Clinical Excellence Commission, in collaboration with clinicians and consumer advisors, developed a Last Days of Life toolkit.

The toolkit provides tools and resources to ensure all dying patients are recognised early receive optimal symptom control, have social, spiritual and cultural needs addressed, both patient and families/carers are involved in decision-making, and bereavement support occurs.

The tools have been specifically developed for use by generalist clinicians and are not intended to replace either local Specialist Palliative Care guidelines or advice given by Specialist Palliative Care clinicians. The tools have been developed through consensus opinion and review of NSW Health policy, Clinical Pathways, End of Life Plans and guidelines from all Local Health Districts as well as the clinical expertise provided by working group members.

The various tools developed relate to:

  • Recognition of the dying patient, management planning and care after death;
  • Medication prescribing for symptom management;
  • Accelerated transfer to die at home;
  • Communication.

The Last Days of Life Toolkit Pilot Summary

Following extensive consultation, a pilot approach was undertaken between September and December 2016 to test acceptability and usability. Overall the response was very positive and the tools were seen as appropriate and suitable for the care and management of the dying patient.