On this page you can find information about:
Advance care planning (ACP) is a process that gives people a chance to think about and write down what is important to them. A person must have mental capacity to make an advance care plan and might find it useful to talk to professionals about their care options.
The person may record information about who knows them best, where they wish to be cared for and the type of care they would like to receive at the end of life.
This type of information helps health care professionals, family and carers to know as much as possible about the individual’s wishes and preferences and should be part of the process of communicating such wishes with those who are important to the person and others who may have an impact on that person’s future care such as the GP.
An ACP form is available on ADT dashboard. These forms are attached to a current care episode. Following completion of an ACP the Health Care Professional must click SUBMIT and create an ACP ALERT within dashboard detailing the date and time of completion. The form can then be viewed within PENS regardless of patient location. ACP decisions should be reviewed on subsequent admissions.
Completion of an ACP should be recorded in discharge documentation (Medical, Nursing, AHP). The ACP policy can be viewed on the Document Management System (DMS).
There are a number of ways in which someone can formalise an ACP discussion:
Advance statement of wishes and preferences
An Advance Care Planning Proforma can be found on ADT dashboard.
This is a persons own record of their wishes and preferences. It is not legally binding but if it is shared with health professionals it can be taken into account when making decisions in the persons best interests.
Lasting power of attorney
The person may document in their advance statement of wishes and preferences, who they would wish to speak for them, should they lose capacity, however, if they wish to legalise this they can create a lasting power of attorney (LPA). This is a trusted person named by the individual to act on their behalf. There are two types of LPA; one for health and welfare and one for finances.
For further information visit www.
Advance decision to refuse treatment
This is a legal document that has been developed nationally for patients to specify in advance which treatments they do not wish to have in the future. It does not have to be written on a specific form but there has to be specific wording to ensure the document is legal.
For further information visit the NHS website or the Office of the Public Guardian website.
The end of life care plan is an essential document to promote individualised planning of care for patients who are recognised to be dying.
The care plan has been developed in line with NICE guidance for patients, their families and carers when an individual is in the final days of life.
The document follows a multi-disciplinary approach to patient care. Once it is recognised that a patient is dying, important discussions can be held with the patient (where possible) and their relatives/carers. These conversations should be based around the ongoing plan of care, decision making and any wishes and preferences for both the patient and the family/carers during this difficult time.
The personalised plan of care for the dying person (PPCDP) is on PENS, for further information or training please contact tina.
Top tips for an individualised end of life care plan
- It should always be initiated following Multi-Disciplinary team (MDT) agreement that the patient is in the dying phase (which may be hours or days) This may be completed by nursing or medical staff with the consultants agreement. Medical staff should complete the daily medical review template and nurses should complete the Nursing day assessment (Palliative Care Version)
- Include the patient and family/ IMCA in all discussions where possible
- A personalised plan of care for the dying person can be commenced without input from the Specialist Palliative Care team if the ward team feel confident to support care.
Symptom Control Medication for the Dying Person
The following link provides guidance on Symptom Control Medication for the Dying Person. Please contact the Specialist Palliative Care Team if further advice is required.
Syringe pump/drivers are an important piece of medical equipment to help maintain good symptom control. They can provide a useful alternative method of administration of medication when it cannot be taken orally.
High risk device
It is mandatory that staff have self-assessed their own competency statement and have been observed as competent by an appropriate supervisor, prior to using a high-risk medical device without supervision. This training and assessment is valid for 12 months and therefore competency must be reassessed yearly.
Syringe pump/driver training is on ESR – search driver and complete “LUH (AC) Syringe Driver Training e-learning”.
Please email: pall.
Syringe pump/drivers are available via ward equipment (Aintree site) on ext. 2816 or bleep 2816 – staff will need to provide the patients name and RQ number. Out of hours syringe drivers are available from night stores.
For the Royal and Broadgreen these are available from the Equipment pool on the 3rd floor, return to this location when no longer needed.
Top tips for use of syringe pumps/drivers:
- A syringe pump/driver is a 24-hour continuous subcutaneous infusion (CSCI)
- A syringe pump/driver must be prescribed on a paper prescription specific to syringe pumps/driver
- Ensure syringe pump/driver is prescribed on Wellsky
- Stop all Modified Release (12hrly) oral opiates
- Continue all PRN medications
- Use a 30ml luer lock syringe and make up to a total of 23mls (total of drug combination and diluent)
- Never give a bolus from the syringe driver
- All syringe pumps/drivers should be in a lock box
- Check drivers every four hours and document checks
- Keep drivers out of direct sunlight
- Keep out of water including showers.
It can be difficult to be certain that a person is dying, but it is essential to recognise the signs of dying in order to provide appropriate care for people at the end of life, recognising dying takes knowledge and skill.
The terminal phase may last for hours or several days. Professionals, patients or carers may recognise that someone is dying.
A deterioration in the patient’s condition could suggest that the patient may be dying.
Things to consider:
- MDT assessment – is there a potentially reversible cause for the patient’s condition? e.g opioid toxicity, renal failure, infection, hypercalcaemia
- People are likely to be in the terminal phase when have deteriorated day by day, become progressively weaker, they are likely to have reduced appetite and have difficulty taking oral medication, they are likely to have a deterioration in level of consciousness
- Ensure a uDNACPR is completed
- Ensure anticipatory medications are prescribed
- Ensure the patient (if appropriate) and relatives/carer and involved in discussions and are aware that the patient is dying
- Continue to reassess and review the current plan of care.
Remember the five priorities of care of the dying person: recognise, communicate, involve, support, and plan and do.
For more information visit the Government website here.
The Volunteers' Department offer a support service for patients, their family and carers when the patient is in the final stages of their life.
Volunteers can help by:
- Listening to the requests of patients and their family/carers
- Signposting the patient and their family/carers to the appropriate professional
- Showing understanding and compassion to the patient and their family/carers to the appropriate professional
- Showing understanding and compassion to the patient and their family/carers
- Communicating any concerns about the patient and their family/carers to the Nurse in Charge of the ward
- Ensuring family/carers have access to refreshments and are aware of the facilities available to them.
This service is available from 8.30am-4.30pm, Monday-Friday.
Contact details
- Aintree: Ext 2408/3996 or mobile 07543180514
- Royal: Ext. 3170 or mobile 07543184263
- Broadgreen – 0151 529 2408.
Communication with those important to the patient
The way in which we inform someone of the death of a loved one can influence the bereavement process.
It is important that we approach this in a sensitive manner.
Breaking bad news
- Before informing the person that the patient has died, confirm the correct information is available and that the correct nominated person is being contacted
- If the patient has died during the night ensure that the nominated person has already agreed to being contacted overnight
- All communication with family/loved ones must be undertaken in a sensitive and transparent manner
- Make sure you will not be interrupted before starting the conversation
- Ensure you have the correct information to hand before speaking with family/loved ones
- Allow the patients family/loved ones to ask questions and/or express concerns.
Breaking bad news over the telephone
Breaking bad news should ideally be done face-to-face however this is not always possible.
Consider the following before making the decision to break bad news over the telephone:
- Is it appropriate to break bad news over the telephone?
- Whether you are the most appropriate person to deliver this news
- What knowledge the bereaved person may have about the patients’ condition prior to death
- When the person last saw the patient
- The age and health of the person
- How far the person may have to travel to reach the hospital
- Language barriers, speech, hearing or language
- Whether they wanted to be contacted over the telephone or during the night/have any previous discussions taken place.
Once the decision has been made to break the bad news over the telephone:
- It is essential to confirm the correct information i.e. the correct patient and the bereaved person are identified
- Do not imply or state that the patient is alive at the time of the call if they are not as omitting the truth or facts may not be helpful later
- Make sure you will not be interrupted when making the call
- Check the location and whether they are alone
- State who you are when calling and whether you have met or spoken to them previously
- Acknowledge the difficulty of having this conversation over the telephone
- Be direct and clear with the information you give. Confirm that death has occurred use the words that the patient has died
- Make sure you have time to listen and answer any question the person may have
- Offer that they can phone back with any questions or queries and provide a point of contact
- Do they want to see the deceased patient? Not all people do so ask if there are any other loved ones that will want to visit.
A guide to breaking bad news over the telephone short video.
Relatives and carers of the dying patient will require additional support and comfort during this difficult time.
Ward staff should consider the following:
- Ensure relatives are given the tear-out information sheet when the patient is commenced on the end of life care plan, if the plan is not commenced these leaflets are available separately and can still be provided. Leaflets are available from the ward based end of life documentation – contact the palliative care team if more are required
- Spiritual and religious support – staff should offer this option to relatives to clarify if they would like some religious or spiritual support
- The end of life volunteer companion service offer support for patients, their family and carers when the patient is in the final stages of life
- The use of mobile phones is permitted in most clinical areas with some restricted areas such as within the radiology department. Unfortunately, the charging of phones is not permitted
- Visitor food and drink – relatives should be informed by ward staff of where they can obtain refreshments. Staff on the wards should also be able to provide relatives with some drinks when staying with a loved one during the terminal phase
- If a relative is staying overnight, ward staff should arrange for blankets, pillows and a visitor bed if available
- Car parking - in certain circumstances free parking can be made available to those close relatives who are staying with the patient during the terminal phase, nurses should speak to their nurse in charge to organise this via the online system.
The Cherry Blossom Suite is a facility available on the Aintree site for visitors of dying or vulnerable patients, for more information click on the link:
The Chaplaincy seeks to address the spiritual and religious needs of the hospital community.
The Chaplaincy incorporates all the major Christian denominations and is strongly associated with all the major faith communities. The chaplaincy is available for those of all faiths and also for those who do not belong to a particular faith community but recognise their own spiritual journey.
The work of the Chaplaincy aims to support both providers and users of health services. It offers a response - also in the content of a system of faith or belief - to the spiritual, religious and emotional needs which arise from changes in health and wellbeing.
Visit the Chaplaincy page for further information; this includes links to multi-faith guidelines on specific cultural practices when caring for the dying person and care after death.
The Safe Transfer tool acts as an aide memoire to assist with the safe discharge of palliative and end of life patients in the final days, weeks and months of life.
This resource should be utilised regardless of discharge destination. The tool can be completed by members of the MDT, however, the responsibility for the final check before discharge is with the registered nurse responsible for the patient's care.
The document is available on PENS and guidance is available via the DMS.
More information is available on the Palliative and End of Life notice boards in ward areas or via these End of Life resources.
