New Guidelines proposed for Improving Standards of Care at the End of Life


England's health watchdog has put forward new draft guidance, which it is hoped will improve the care of adults in their last few days of life. The new draft guidelines come after concerns that misuse of the Liverpool Care Pathway led to some patients being deprived of water and food. The Liverpool Care Pathway was introduced in the late 1990s, in an attempt to ensure people had a dignified and comfortable death. It involved a checklist to ensure patients were free from invasive procedures and medications that were no longer necessary.

An independent review found that unfortunately, decisions were sometimes taken by inexperienced staff. The National Institute for Health and Care Excellence acknowledges that many of the failings were down to how the Liverpool Care Pathway was implemented - rather than as a direct consequence of the document itself.

New Guidelines proposed for Improving Standards of Care at the End of Life

The new draft proposals encourage staff to involve patients and relatives in decisions and to communicate well. The focus is on providing personalised care, good communication and shared decisions between staff, relatives and patients when appropriate. Medical and Nursing Staff are advised to undertake daily reviews of medication and check if people are thirsty or need more nutrition. According to the guidelines patients must be monitored for any improvements and if there is any uncertainty staff should seek help from more experienced colleagues. The National Council for Palliative Care supports the strong focus on personalised care/individual needs in the draft guidelines.

The President of the Association of Palliative Medicine, says the concerns with the Liverpool Care Pathway were a wake-up call to change the system: "The problem in a sense with an industrialised approach to managing dying people is that everyone gets preoccupied with ticking the boxes and not looking at the person in front of them...Let's not forget we are dealing with people who are dying and who are distressed and actually bedside assessment, communication - the milk of human kindness - is what matters..."

End of Life Care is ‘everybody’s business’ and it is essential that those who are nearing the end of their lives receive care which is of the highest standard as there is only one chance to ‘get it right’.

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