It is important that the patient is known to have advanced disease or frailty and that reversible causes of deterioration have been excluded.
The assessment that a patient is in the last days of life should be made by the multidisciplinary team in discussion with the patient and relatives as appropriate.
When it is thought that a person may die within the next few days or hours:
a) Stop non-essential medication e.g.
b) Prescribe medication via a suitable route (e.g. subcutaneous injection or syringe driver/pump) for:
There will be geographical variation in recommended drugs for the dying phase (eg morphine vs diamorphine). Please cross reference with local guidelines/prescribing policies.
Consider appropriate dose reductions in severe frailty or organ failure (see previous chapters)
c) Essential drugs that cannot be given by the usual route should be changed to an alternative (e.g. anticonvulsants converted to subcutaneous midazolam, steroids to dexamethasone sc).
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.