Patients in their last days of life should be encouraged to drink “if they wish to and are able to”, according to new draft guidance from the National Institute for Health and Care Excellence.
The draft guidance also said that, if considered beneficial, end of life care patients should receive assisted hydration.
“The guideline we are developing will ensure that people who are nearing the end of their lives are treated with respect and receive excellent care”
However, this should be monitored at least once a day and fluids reduced or stopped if there is any sign of harm or no sign of benefit, said NICE. People should also be given frequent mouth care.
The publication of the draft guidance follows the abolition of the controversial Liverpool Care Pathway, which was phased out last year after a review by the Health Service Ombudsman found serious failings in the way it was being used.
In June last year a set of guiding principles for the care of dying people, called the Priorities for Care, was published to replace the axed care pathway.
Asked by Nursing Times how the NICE guidance would fit in with the priorities framework, a spokeswoman for the institute said: “The framework sets out the main priorities for care and our guideline will set out best practice to support staff to achieve these.”
- Liverpool Care Pathway ‘to be replaced’
- New ‘approach’ to end of life care replaces axed Liverpool pathway
- New palliative care guidelines launched for NHS in Scotland
The new NICE guidance, which is out for consultation, makes a series of recommendations covering key areas such as the prescribing of medicines, care plans and communication, as well as hydration.
It also lists signs and symptoms that may indicate death is imminent in an effort to ensure people do not miss out on treatment and care that could make their final days more comfortable.
Crucially, the document stresses the need for nurses and doctors to communicate clearly with the dying person and their family and ensure they are fully involved in decisions about treatment.
Some families who contributed to the review of the Liverpool Care Pathway said their elderly relatives had been placed on the pathway without their knowledge or consent.
The new draft guidance said it was important to identify the most appropriate member of the healthcare team, which may well be a nurse, to talk through the patient’s prognosis with them based on “confidence and competence” and their “relationship and rapport”.
It emphasised the need to provide accurate information and explain any uncertainty “avoiding giving false optimism” and to ensure patients and their loved ones have the chance to talk about their concerns and ask questions.
Multi-professional teams should create an “individualised plan of care”, which includes the dying person’s wishes, such as where they would prefer to die and how they would like symptoms to be managed.
They should also identify a “named lead healthcare professional, who is responsible for encouraging shared decision-making in the person’s last days of life”.
In addition, the draft guidance highlighted areas where more research was needed to help improve end of life care.
The consultation on the draft guidance is open until 9 September, with the final document due out in December.
NICE chief executive Sir Andrew Dillon said: “Recognising when we are close to death and helping us to remain comfortable is difficult for everyone involved.
“The Liverpool Care Pathway was originally devised to help doctors and nurses provide quality end-of-life care. While it helped many to pass away with dignity, it became clear over time that it wasn’t always used in the way it was intended,” he said.
“The guideline we are developing will ensure that people who are nearing the end of their lives are treated with respect and receive excellent care,” he added.
“The draft guideline marks an important step forward”
But the charity Marie Curie said its research suggested that as many as 92,000 people a year in England do not get palliative care, because healthcare professionals have failed to recognise they are at the end of life.
Medical director Professor Bill Noble welcomed the NICE guidance but said it was vital the recommendations were backed up by training for nurses and others.
“The draft guideline marks an important step forward and could form the basis of continuous professional development and training for health and social care professionals in recognising and providing care for terminally ill and dying people,” he said.
“Without this kind of training to embed the NICE guidelines, failings in care identified in the recent Health Service Ombudsman report will continue and may worsen,” he added.