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Care in the last days of life

Quality statement

People in the last days of life are identified in a timely way and have their care coordinated and delivered in accordance with their personalised care plan, including rapid access to holistic support, equipment and administration of medication.

Quality measure

Measures from End of life care strategy: quality markers and measures for end of life care (Department of Health 2009) (see source references).

Indicators from End of Life Care Quality Assessment Tool (ELCQuA) (National End of Life Care Programme 2011) (see ELCQuA indicators relevant to NICE quality statements).

See Measuring the quality statements for further information on the above and guidance on how to use these and the below supplementary measures.

Structure

Evidence of local arrangements to ensure that people in the last days of life are identified in a timely way.

Outcome

Families and carers of people in the last days of life feel that everything was done to meet the person's needs and preferences during this time, as far as possible.

See Measuring the quality statements for overarching outcomes.

Description of what the quality statement means for each audience

Service providers ensure they have systems in place to identify people who are in the last days of life in a timely way, and that care is coordinated and delivered in accordance with their personalised care plan. Systems for rapid access to holistic support, equipment and administration of medication should be in place.

Health and social care professionals identify people in the last days of life, and coordinate and deliver care in accordance with their personalised care plan. Local procedures should be followed to ensure rapid access to holistic support, equipment and administration of medication.

Commissioners ensure they commission services that identify people who are in the last days of life in a timely way, and that coordinate and deliver care in accordance with their personalised care plan. Services should provide rapid access to holistic support, equipment and administration of medication.

People in the last days of life are identified and receive care according to their care plan, which takes into account their needs and preferences, and ensures they can have rapid access to all the support they need, including equipment (such as a pressure-relieving mattress) and medication.

Source references

Department of Health quality markers and measures for end of life caretop ten quality marker for providers 9 and markers and measures 2.10, 3.9, 3.14, 3.17, 4.6, 4.11, 5.5, 5.11, 6.5, 6.11, 8.5, 8.6, 10.4 and 10.6.

Data source

Structure

Local data collection.

Outcome

Local data collection. Office for National Statistics (ONS) National bereavement survey (VOICES)includes questions on care in the last 2 days of life.

The following data sources may also be relevant to the referenced measures:

The National care of the dying audit - hospitals collects data on prescribing rates for anticipatory medication and patient-reported comfort in the last hours and days of life. Compliance with completion of the Liverpool Care Pathway for the dying patient (LCP) is also collected.

The draft End of life care locality register pilot programme core dataset from the Information Standards Board records access to anticipatory medicines/just in case box and whether an end of life care tool is in use. The draft comprehensive dataset includes home access to a syringe driver, catheter continence products and other equipment.

Definitions

'The last days of life' is the period of time when death is imminent and when the time before the anticipated death is being measured in days. Gold Standards Framework prognostic indicator guidance is an example of available guidance to assist generalist clinicians with identification of this phase.

A system of care, such as the LCP or equivalent integrated care pathway, may be helpful in planning, coordinating and delivering safe and effective care in the last days of life. Any standardised tool should be individualised to the needs and preferences of the person dying and their families and carers.

'Holistic' includes, as a minimum, physical, psychological, social, spiritual, cultural, and where appropriate, environmental considerations. This may relate to needs and preferences as well as associated treatment, care and support.

This page was last updated: 13 December 2011

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Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.