In the dying phase, it will be appropriate to review and discontinue some of the patient’s medication (in consultation with the Cardiology or Specialist Palliative Care Team).
In general continue with medications with symptomatic benefits and stop those aimed at medium to long term reductions in morbidity and mortality.
Consider continuing with following as they may be providing symptomatic benefit:
Reassess the value of the following and consider stopping:
For patients who are in the dying phase and who have an active defibrillator in situ, there is a risk of inappropriate shocking by the device; metabolic or biochemical abnormalities may lead to an agonal cardiac rhythm triggering the defibrillator, a situation which must be avoided in the dying patient.
Proactive deactivation of the defibrillator function of a device according to local guidelines and policy prevents the distress of inappropriate shocks as a patient dies.
It is possible to deactivate the defibrillator function but preserve the pacing mode of CRT-D devices.
This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.