End of life care

Elements once end of life care established:

• Palliative care, social work, pastoral care/external religious entity
• Priority symptom control
  • Analgaesia - morphine 5mg q1h subcut PRN
  • Anti-emetics - metoclopramide, haloperidol, cyclizine
  • Agitation - midazolam 5mg q1h subcut PRN
  • Secretions - glycopyrronium 400microg subcut q4h PRN
• Syringe drive if 3 or breakthrough doses required in 24 hours
• Discontinue regular medications, vital signs, oxygen, antibiotics, blood tests, artificial hydration or nutrition, deactivate implantable defibrillator
• Family meeting
• Single room
• Consideration of NGT/IDC
• Mouth cares
• Establish whether coroner's case and inform family
• Check if patient is a potential organ donor
• Inform GP
• Update goals of care
• Remove canula