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| Doctors urged to treat dying patients as individuals | Doctors urged to treat dying patients as individuals |
| (about 2 hours later) | |
| End of life care in England must be tailored to the needs of each patient, rather than a "tick-box approach", new guidelines from NICE say. | |
| The watchdog says doctors and nurses must focus on individuals rather than offer one-size-fits-all care. | |
| The guidance is designed to address misuse of the previous system - the Liverpool Care Pathway - which left some patients without food and water. | The guidance is designed to address misuse of the previous system - the Liverpool Care Pathway - which left some patients without food and water. |
| Charities welcomed the changes but warn that more investment is needed. | Charities welcomed the changes but warn that more investment is needed. |
| Transforming care | Transforming care |
| The Liverpool Care Pathway (LCP) was introduced in the late 1990s, in an attempt to ensure people had a dignified and comfortable death. | The Liverpool Care Pathway (LCP) was introduced in the late 1990s, in an attempt to ensure people had a dignified and comfortable death. |
| Among other things, it involved checklists prompting staff to consider whether invasive procedures, drips and drugs should be withdrawn from people in the last stages of life. | Among other things, it involved checklists prompting staff to consider whether invasive procedures, drips and drugs should be withdrawn from people in the last stages of life. |
| But it was phased out last year after a government-commissioned review revealed serious concerns that it was being used in the wrong way, leading to a "tick-box" culture with some people put on the Pathway without their family's knowledge. | But it was phased out last year after a government-commissioned review revealed serious concerns that it was being used in the wrong way, leading to a "tick-box" culture with some people put on the Pathway without their family's knowledge. |
| The new, wide-ranging guidelines, produced by the National Institute of Health and Care Excellence, cover many of the same key principles as the LCP, but call for a stronger focus on individual plans for each patient. | The new, wide-ranging guidelines, produced by the National Institute of Health and Care Excellence, cover many of the same key principles as the LCP, but call for a stronger focus on individual plans for each patient. |
| And NICE says the wishes of the patients and those close to them must be central. | And NICE says the wishes of the patients and those close to them must be central. |
| Prof Sam Ahmedzai, chairman of the NICE group, said this needed to be underpinned by a change in attitude to ensure staff had more respect for care of the dying. | Prof Sam Ahmedzai, chairman of the NICE group, said this needed to be underpinned by a change in attitude to ensure staff had more respect for care of the dying. |
| Meanwhile the panel of experts acknowledged that recognising whether someone is in the last few days of life while being aware that some patients might improve, can be difficult. | Meanwhile the panel of experts acknowledged that recognising whether someone is in the last few days of life while being aware that some patients might improve, can be difficult. |
| The guidelines emphasise that patients must be monitored for any improvements daily. Staff are offered information on how to spot signs that death is imminent. | The guidelines emphasise that patients must be monitored for any improvements daily. Staff are offered information on how to spot signs that death is imminent. |
| Experts say staff should seek guidance from senior colleagues if there are uncertainties and avoid snap decisions. | Experts say staff should seek guidance from senior colleagues if there are uncertainties and avoid snap decisions. |
| Hydration | Hydration |
| The document also looked closely at hydration for people in their last few days of life. | The document also looked closely at hydration for people in their last few days of life. |
| Previous reports suggested that when the LCP was used incorrectly some patients were left so thirsty they tried to suck water from sponges used to moisten their mouths. | Previous reports suggested that when the LCP was used incorrectly some patients were left so thirsty they tried to suck water from sponges used to moisten their mouths. |
| The new guidance says anyone who is capable of drinking should be encouraged to do so if it is safe and family and friends should be able to help. | The new guidance says anyone who is capable of drinking should be encouraged to do so if it is safe and family and friends should be able to help. |
| And for people with signs of dehydration who cannot drink, a trial of fluid given via a different route - for example, under the skin - should be considered. | And for people with signs of dehydration who cannot drink, a trial of fluid given via a different route - for example, under the skin - should be considered. |
| But despite these recommendations, experts say there is a lack of evidence about whether giving or withholding fluids can prolong or shorten life in these circumstances. | But despite these recommendations, experts say there is a lack of evidence about whether giving or withholding fluids can prolong or shorten life in these circumstances. |
| Commenting on the report, Michael Howard, chairman of Hospice UK, said though the guidelines were welcome there would be real challenges putting them into practice. | Commenting on the report, Michael Howard, chairman of Hospice UK, said though the guidelines were welcome there would be real challenges putting them into practice. |
| Lord Howard added: "There can never be 'a tick-list approach' towards caring for the dying and this guidance must be underpinned by greater investment in training and education for all staff involved in end-of-life care. | Lord Howard added: "There can never be 'a tick-list approach' towards caring for the dying and this guidance must be underpinned by greater investment in training and education for all staff involved in end-of-life care. |
| "This is crucial if we are to avoid the failings of how the Liverpool Care Pathway was implemented." | "This is crucial if we are to avoid the failings of how the Liverpool Care Pathway was implemented." |