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Doctors urged to treat dying patients as individuals NICE urges doctors to treat dying patients as individuals
(34 minutes 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.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 health watchdog says doctors and nurses must focus on individuals rather than offering 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 new guidelines - but warned more investment was needed.
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other things, it involved checklists prompting staff to consider whether invasive procedures, drips and drugs should be withdrawn from people in the last stages of life.Among other things, it involved checklists prompting staff to consider whether invasive procedures, drips and drugs should be withdrawn from people in the last stages of life.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. 'Individualised approach'
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. 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.
And NICE says the wishes of the patients and those close to them must be central. The new wide-ranging guidelines, produced by the National Institute of Health and Care Excellence (NICE), cover many of the same key principles as the LCP, but call for a stronger focus on individual plans for each patient.
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. NICE says the wishes of the patients and those close to them must be central.
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. Palliative care
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. A good death: Can guidelines really help?
Experts say staff should seek guidance from senior colleagues if there are uncertainties and avoid snap decisions. UK end-of-life care 'best in world'
Liverpool Care Pathway: Your experiences
Prof Sam Ahmedzai said this needed to be underpinned by a change in attitude to ensure staff had more respect for care of the dying.
"The main thing that is different is that we are saying we would want to have an individualised approach rather than applying a blanket approach," he said.
The expert panel acknowledged that recognising whether someone is in the last few days of life can be difficult.
Staff should seek guidance from senior colleagues if there are uncertainties and avoid snap decisions, the panel said.
The guidelines emphasise that patients must be monitored for improvements on a daily basis. Staff are offered information on how to spot signs that death is imminent.
HydrationHydration
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.
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. Lord Howard, chairman of Hospice UK, welcomed the guidelines but said 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. "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," he added.
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