Recognising the Patient is Dying

When a person’s condition deteriorates unexpectedly, and it is thought they may die soon, i.e. within a few hours or very few days, they must be assessed by a doctor who is competent to judge whether the change is potentially reversible or the person is likely to die. If the doctor judges that the change in condition is potentially reversible, prompt action must be taken, provided that is in accordance with the person’s wishes or in the their Best Interests if it is established that they lack capacity to make the decision about treatment at that time.

If the senior responsible doctor judges that the person is likely to be dying, taking into account the views of others caring for the person, this must be clearly and sensitively explained to the person in a way that is appropriate to their circumstances (if conscious and they have indicated that they would wish to know), and their family and others identified as important to them.

More often a patient will deteriorate predictably over a period of days. When it is apparent that a person is close to death this must be communicated with the family/carers and their caring team. Patients and those important to them should be offered the opportunity to discuss what to expect at this time. If the senior responsible doctor/nurses do not feel competent to have this discussion, it is imperative they seek a colleague (e.g. a member of the Specialist Palliative Care Team) for support. Patients (where appropriate) and those important to them should be offered written information about the dying process.

The person’s views and preferences must be taken into account, and those important to them must be involved in decisions in accordance with the person’s wishes. A Plan of Care must be developed and documented. The person must be regularly reviewed to check that the Plan of Care remains appropriate and to respond to changes in the person’s condition, needs and preferences.

Recognising dying is the ultimate trigger to review any Advance Care Plan or Priorities for Care at this period. Professionals should document an individual plan for the patient’s care using existing notes or Care Plans, taking into account any expressed preferences. This is a change from previous recommendations to document all care on a shared pathway.

Regular review of the patient and carers wishes should be documented. The fact that a person is very close to dying should be written in their Care Plan. If a patient in hospital is believed to be in the last days of life and they wish to die at home, Rapid Discharge should be considered. Recognising dying is equally appropriate in the event of acute illness leading to death, even if the patient has not previously been diagnosed as being in the last days of life.