National Care of the Dying Audit of Hospitals

Key recommendations

• Hospitals should provide a face-to-face specialist palliative care service from at least 9am to 5pm, 7 days per week, to support the care of dying patients and their families, carers or advocates.
• Education and training in care of the dying should be mandatory for all staff caring for dying patients. This should include communication skills training, and skills for supporting families and those close to dying patients.
• All hospitals should undertake local audit of care of the dying, including the assessment of the views of bereaved relatives, at least annually.
• All trusts should have a designated board member and a lay member with specific responsibility for care of the dying. Trust boards should formally receive and discuss the report of local audit at least annually.
• The decision that the patient is in the last hours or days of life should be made by the multidisciplinary team and documented by the senior doctor responsible for the patient’s care. This should be discussed with the patient where possible and appropriate, and with family, carers or other advocates.
• Pain control and other symptoms in dying patients should be assessed at least 4- hourly and medication given promptly if necessary. Interventions should be discussed with the patient where possible and appropriate, and with family, carers or other advocate.
• Decisions about the use of CAN and CAH are complex and should be taken by a senior experienced clinician supported by a multidisciplinary team. They should be discussed with the patient where possible and appropriate, and with family, carers or other advocates.
• Hospitals should have an adequately staffed and accessible pastoral care team to ensure that the spiritual needs of dying patients and those close to them are met.