Frimley Guidelines

Care and Support of the Dying Patient in the ED (FPH)

Key Points

This abridged guidance is a quick reference tool for use only within the ED (first 12 hours)Other relevant guidelines for reference:

Version:2.0
Date Issued:17/01/2024
Review Date:17/01/2027
Key words:Palliative, Dying, Emergency, Dignity, Comfort

This is a controlled document. If you are using a printed copy, check it against the guidelines site to ensure you are using the latest edition. Print copies must be destroyed after use.

Abbreviations

DNACPRDo Not Attempt Cardiopulmonary Resuscitation
EDEmergency Department
OOHOut of Hours

Nursing care

Transfer to hospital bed.

Four hourly comfort monitoring, but hourly if symptomatic.

Symptom control

   
Symptom   		   
Medication   
   
Pain or   Breathlessness   		   
Morphine   Sulphate 2.5-5mg SC PRN /2 hourly
   
   
   
Anxiety
   
Delerium   
Midazolam 2.5-5mg SC PRN /hourly

Haloperidol* 2.5mg SC PRN /2hourly OR Levomepromazine** 6.25mg SC PRN/BD
   
Respiratory   Secretions   		   
Hyoscine ButylBromide (Buscopan) 20mg SC PRN   /2hourly   
   
Nausea   and Vomiting   		   
Haloperidol* 0.5-1.5mg   SC PRN/TDS OR
   
Levomepromazine   ** 6.25mg SC PRN/BD   

* avoid in Parkinson’s disease

** caution with history of raised ICP or seizures

Other Things to consider:

Refer to Palliative Care (Bleep 799 8.30-4.30 Sun-Fri)

+ Epic order “inpatient consult to palliative care

End of Life Companions (via Switchboard, 8am-8pm every day)

DNACPR form, Discontinue NEWS scoring

Mouth care

Swallowing - offer food and drink

Catheterisation for urinary retention

Glycerine suppositories for constipation

Air mattress / repositioning

Check if advanced care plans are in place

Stop regular medicines

Involve Chaplaincy team (Bleep 055 x4184 8am-4pm Mon-Fri, OOH via switchboard)