THE DYING PHASE – USING THE LIVERPOOL CARE PATHWAY
It is important that the patient is known to have advanced disease and that reversible causes of deterioration have been excluded.
Usually the dying phase can be recognised from the following features³:
• unconscious / sleeping much of the time
• little interest in food/fluids
• unable to swallow tablets
• largely bed-bound
The assessment that a patient is in the last days of life should be made by the multidisciplinary team in discussion with the patient and relatives as appropriate.
At this stage, only drugs that are required for comfort and symptom control should be prescribed:
a) Stop non-essential medication e.g.
- cholesterol-lowering agents such as statins
- anti-hypertensive drugs
Consider whether reducing or stopping steroids in patients with raised intracranial pressure is appropriate.
b) Prescribe medication and ensure available via a suitable route for:-
e.g. subcutaneous injection or syringe driver
c) Essential drugs that cannot be given by the usual route should be changed to an alternative (e.g. anticonvulsants converted to subcutaneous midazolam).