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NICE outlines commissioners targets for palliative care

NICE outlines commissioners targets for palliative care

End of life guidelines have been released by the National Institute for Health and Care Excellence (NICE) in order to provide “consistent, compassionate and high quality” care
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End of life guidelines have been released by the National Institute for Health and Care Excellence (NICE) in order to provide “consistent, compassionate and high quality” care.

It recommends commissioners focus on ensuring an individualised approach to anticipatory prescribing, and ensuring health professionals can access the equipment needed for clinically assisted hydration.

The NICE guideline follows the abolition of the Liverpool Care Pathway, a protocol for looking after people at the end of their life which was phased out last year after a government-commissioned review found serious failings in how the pathway was being implemented.

The pathway “became increasingly controversial over the years with stories of fluids and medicines being withheld, over-sedating the dying person... It became seen as a ‘tick-box exercise’ and a ‘one-size-fits-all’ approach,” Sam Ahmedzai, a professor of palliative medicine and chair of the experts who developed the guideline, explained.

The review also found that a 'proforma' approach to prescribing led to over-medication, and inexperienced staff were inappropriately prescribing and administering medicines.

Therefore commissioners should develop agreements with local pharmacies to keep an agreed list of drugs in stock and provide community staff with details of local on‑call pharmacies, the guidance stated.

It also recommended that nurses and other healthcare professionals create an individualised care plan in discussion with the dying person, those important to them and the multi-professional team. Commissioners should “ensure that healthcare professionals in all care settings have access to the equipment needed for clinically assisted hydration,” it read.

Practice varies widely in the use of clinically assisted hydration at the end of life, and there is no evidence that providing clinically assisted hydration will prolong dying, or that 'withholding' it will hasten death.

It’s estimated that about half a million people die each year in England and three out of four of these deaths are expected.

See the full guideline here.

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