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Care for the Dying: A Pathway to Excellence by John Ellershaw, Susie Wilkinson

By John Ellershaw, Susie Wilkinson

Marie Curie Centre Liverpool, united kingdom. textual content offers instructions for the care of the demise in accordance with the Liverpool built-in Care Pathway for the death sufferer (LCP). comprises evidence-based practices and describes the method of care and results. Discusses bedside documentation platforms, rules and strategies, criteria of perform, and caliber development courses. Softcover.

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An example is given in Appendix 6. This section must also be signed and dated by the nurse. Have you completed the last 4 and 12 hourly observations? This prompt is placed at the end of this section merely as a reminder to nurses to return to the Ongoing Assessment section and ensure they have recorded the patient’s final observation. Initial analysis of the LCP found that nearly one third of final observations were missing, however, since adding this prompt to the pathway consecutive yearly data has reduced the missing data around the final observation to approximately 10%.

2. The second step is to do a psychosocial assessment, to try to identify any ‘pain threshold’ issues that are complicating the pain. This may be quite difficult to assess in the imminently dying patient and will often present as terminal agitation/restlessness (see next section). 3. The third step is to consider using opioids—and if they are indicated, to use them correctly, according to the standard principles (10). For patients being put on the LCP, HOW DO YOU MANAGE PAIN IN THE DYING PATIENT?

In countries where diamorphine is not available, hydromorphone or morphine tartrate have similar solubility to diamorphine. g. oxycodone 30 mg suppositories every eight hours) but is less acceptable to some 45 46 SYMPTOM CONTROL IN CARE OF THE DYING patients/families and is much more limited in what drugs and doses can be administered (11). Fentanyl patches make the transdermal route an obvious alternative to oral in terminally ill patients who are unable to swallow, but there is uncertainty about their use in the dying phase.

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