The Care of Dying Adults in the Last Days of Life Quality Standard (QS144) follows on from the Care of Dying Adults in Last Days of Life (Dec 2015) NICE guideline NG31 which made 72 recommendations for care.
NICE Quality Standards describe high-priority areas for quality improvement in a defined care or service area. Each standard consists of a prioritised set of specific, concise and measurable statements. Quality standards draw on existing NICE or NICE-accredited guidance that provides an underpinning, comprehensive set of recommendations, and are designed to support the measurement of improvement.
The Quality Standard Care of Dying Adults in the Last Days of Life QS144, covers the clinical care of adults (aged 18 and over) who are dying, during the last 2 to 3 days of life. It describes high-quality care in priority areas for improvement.
Whilst seeming to be quibbling about semantics; the Quality Standard does not cover care before the last few days of life, such as palliative care or ‘end of life care’ (often defined as care during the last year or so of a progressive disease), or care after death. These are included in NICE’s Quality Standard QS13 for end of life care for adults.
Within the last days of life Quality Standard there are four quality statements:
Quality statement 1: Assessing signs and symptoms
Adults who have signs and symptoms that suggest they may be in the last days of life are monitored for further changes to help determine if they are nearing death, stabilising or recovering.
Quality statement 2: Individualised care
Adults in the last days of life, and the people important to them, are given opportunities to discuss, develop and review an individualised care plan.
Quality statement 3: Anticipatory prescribing
Adults in the last days of life who are likely to need symptom control are prescribed anticipatory medicines with individualised indications for use, dosage and route of administration.
Quality statement 4: Hydration
Adults in the last days of life have their hydration status assessed daily, and have a discussion about the risks and benefits of hydration options
For each of the four statements there are further detail of rationale, quality measures, what the statement means for different audiences as well as definitions of terms used. It is also worth noting that NICE also publish a number of resources and tools designed to support the implementation of guidance and standards.
In addition, to the four quality statements there is also an interactive flowchart – End of life care for people with life-limiting conditions which is worth a look at.
I caught up with Emeritus Professor Sam Ahmedzai, who chaired the committee that produced the original NICE Care of dying adults in last days of life NG31 guideline. Sam reflected:
“Of course all the 72 recommendations in NG31 are important, but many are admittedly aspirational. The point of the statements in this new Quality Standard is to highlight at least 4 key areas that we think NHS services should be delivering on, to a high degree. And this applies in all settings, whether the patient is at home, in hospital or hospice.”
For further information on all NICE guidance, quality standards and statements visit NICE