POLICIES & PROCEDURES FOR

END OF LIFE CARE

Prepared & Issued By: Approved By:

Dr. G. ANJANEYULU Dr. T. SATISH KUMAR

Medical Superintendent Chairman
Amendment / Revision Status Sheet

S Rev. Date Rev. Section Affected Details of Reason for Approval

No No. Amendment Amendment Signature
01 04-07-16 01 Header& footer, Attached NABH
revision status requirements

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 Controlled Copy Distribution Record

Sr. Controlled No. of Issued to Issue Date

No. Copy No. Copies

1. 01/02 01 Medical Admin 10-07-2016

2. 02/02 01 Counseling Dept. 10-07-2016

1.0 PURPOSE:
1.1 To provide skilful nursing, gentle handling and utmost reverence to the body after
death.
1.2 To fulfill Patients cultural beliefs or personal wishes relating to death and dying; these
must be respected.
1.3 To ensure Infection risks do not increase after death. Death in hospital may necessitate
by law the involvement of the registrar/legal authority.
1.4 To ensure that healthcare workers comply with legislation, the wishes of
patients/relatives and continue to follow Standard Precautions and where necessary.
1.5 To minimize Transmission Based Precautions and any risk of cross-infection.

2.0 SCOPE:
Death Patients at AH.
3.0 RESPONSIBILITY:
Nurse/Housekeeping staff
4.0 POLICY:
2.1 The staff caring for patients at an end stage of life shall identify the emotional
psychological & spiritual / religious needs of dying patients and their families.
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 2.2 The staff shall provide appropriate pain and palliative care according to the wishes of
the family and patient.
2.3 The policies and procedures are in consonance with the legal requirements.
2.4 The clinical team shall help the family in making decisions regarding post mortem,
organ donation etc.
2.5 All the staff shall be educated and trained regarding the end of life care.

5.0 DEFINITION : Nil

6.0 ABBREVIATIONS:

IP : Inpatient

7.0 DISTRIBUTION: All Inpatient Areas

8.0 PROCESS DETAILS:

8.1 The management of patients at the end of life can be divided into two phases.
8.1.1 The first concerns the process of shared decision – making that leads from
the pursuit of care or recovery to the pursuit of comfort and freedom from
pain.
8.1.2 The second concerns the actions that are taken once this shift in goals has
been made and focuses on both the humanistic and technical skills that
must be enlisted to ensure that the needs of the patient and family are met.
8.2 Patient Centered Goals

8.2.1 Identify patients who require end of life care.

8.2.2 The healthcare team has an obligation to provide care that relieves suffering
arising from physical, emotional, social, and spiritual sources

8.2.3 There are five domains of good end-of-life care:

Receiving adequate pain and symptom management, avoiding

inappropriate prolongation of dying, achieving a sense of control, relieving
burden, and strengthening relationships with loved ones.

8.2.4 First and foremost, patients should be assured that management of their
pain and distress will be the highest priority of their caregivers.

8.2.5 Closely related is the need to assure patients that they will be treated with
respect and dignity, both during and after the dying process.

8.2.6 Patients should know that their cultural beliefs are understood and that
cultural expectations will be met.

8.3 Family Centered Goals

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 8.3.1 Although the needs of the patient must be the primary focus of caregivers,
there is growing consensus that a family – centered approach is particularly
important in end-of-life care

8.3.2 The clinical team (Doctors, Nursing personnel, Counselors) must strengthen
the own relationship with the patient’s loved ones by:

8.3.3 Facilitating ongoing communication among family members, and members

of the care team.

8.3.4 Shared decision making between health team and patient/family have to be
made and family’s consent documented in patient case sheet.

8.3.5 Supporting families, and caregivers including grief, and follow-up services.

8.3.6 Ten most important needs of families of critically ill dying patients:

8.3.6.1 To be with the person

8.3.6.2 To be helpful to the dying person

8.3.6.3 To be informed of the dying person’s changing condition

8.3.6.4 To understand what is being done to the patient and why

8.3.6.5 To be assured of the patient’s comfort

8.3.6.6 To be comforted

8.3.6.7 To ventilate emotions

8.3.6.8 To be assured that their decisions were right

8.3.6.9 To find meaning in the dying of their loved one

8.3.6.10 To be fed, hydrated, and rested

8.4 Special Issues in Communicating with families near the time of death

8.4.1 Arrangements for the last wishes of patients or request of family members

8.4.2 Notification of Death.

8.4.3 Organ Donation

8.4.4 Paperwork & discharge formalities

8.5 Needs of the Clinical Team:

8.5.1 Although all members of the clinical team should have active roles in
providing end-of-life care, key aspects of this care should be performed and
modeled by respected clinicians with leadership roles in the institution.

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9.0 RECORDS AND FORMATS: Counseling records & organ donation record
10.0 REFERENCE:
AH/COP/11 : Policies and procedures for End of Life Care

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