End of life management
This information does not replace clinical judgement. Refer to Conditions of use and copyright for further T&Cs.
End of life: recognising and managing the terminal phase of life. Use this pathway in conjunction with Queensland Government Residential Aged Care End of Life Care Pathway (RAC EoLCP)
Flowchart
The flowchart shows all of the information at one time. Health professionals should always remain within their scope of practice; these pathways should never replace clinical judgement.
Click the link below to view the full flowchart.
Practice points
A systemised documentation of expanded relevant information - use only in conjunction with flowchart / decision tree above - note you can access each relevant point from the flowchart / decision tree link.
-
If three or more of the below signs and symptoms are present, AND the resident (or their substitute health decision maker), the GP, and the multidisciplinary team ALL agree, it is appropriate to commence end of life care plan e.g. End Of Life Pathway (RAC EoLP):
- Experiencing rapid day to day deterioration that is not reversible
- Requiring more frequent interventions
- Becoming semi-conscious, with lapses into unconsciousness
- Increasing loss of ability to swallow
- Refusing or unable to take food, fluids or oral medication
- Irreversible weight loss
- An acute event has occurred requiring revision of treatment goals
- Profound weakness
- Changes in breathing patterns
**PLEASE note: in some cases residents may be commenced on an end of life care plan (e.g. RAC EoLCP) and then taken off the pathway if their condition improves.
Where a resident does not meet three or more criteria, assess further for cause of deterioration. If a cause for deterioration is not identified, refer to HHS RaSS at GP discretion
-
Specialist community palliative care services work in collaboration with primary care providers and often provide:
- Visits to the resident in the RACF
- 24 hour telephone on-call services
- Admission to inpatient palliative care beds where indicated
Specialist palliative care services may be accessed via:
Where HHS specific community palliative care services are unavailable:
Additional palliative care resources include:
- How to use Residential Aged Care End of Life Care Pathway
- Guidelines for a palliative approach to care in Residential Aged Care
- Care Search Residential Aged Care palliative care resources
- End of life directions for aged care (ELDAC)
- Principles for palliative and end of life care in residential aged care
References
-
- Residential aged care end of life care pathway (RAC EoLCP). Brisbane South Palliative Care Collaborative (BSPCC). v4. 2013.
- Australian Government, Department of Health and Ageing.. Guidelines for a palliative approach in residential aged care. Enhanced version. 2006. Canberra: Commonwealth of Australia.
- Cardona-Morrell M, Hillman K. Development of a tool for defining and identifying the dying patient in hospital: Criteria for Screening and Triaging to Appropriate alternative care (CriSTAL). BMJ Support Palliat Care. 2015;5(1):78-90.
- Glare P, Sinclair C, Downing M, Stone P, Maltoni M, Vigano A. Predicting survival in patients with advanced disease. Eur J Cancer. 2008;44(8):1146-56.
- Brisbane South Palliative Care Collaborative. Guide to the pharmacological management of end of life (terminal) symptoms in residential aged care residents: a resource for general practitioners. 2015. Brisbane: State of Queensland (Queensland Health).
- Palliative Care Australia, Alzheimer’s Australia, COTA Australia, Aged & Community Service Australia, Leading Age Services Australia, Catholic Health Australia and Aged Care Guild. Principles for palliative and end of life care in residential aged care. Accessed 3/08/2021.
- Australian Commission on Safety and Quality in Health Care. National Consensus Statement: essential elements for safe and high-quality end-of-life care. Sydney: ACSQHC, 2015.
-
Pathway End of life: recognising and managing the terminal phase of life
Document ID CEQ-HIU-FRAIL-00013 Version no. 2.0.0 Approval date 16/03/2022 Executive sponsor Executive Director, Healthcare Improvement Unit Author Improving the quality and choice of care setting for residents of aged care facilities with acute healthcare needs steering committee Custodian Queensland Dementia Ageing and Frailty Network Supersedes End of life V1.1.0 Applicable to Residential aged care facility (RACF) registered nurses and General Practitioners in Queensland RACFs, serviced by a RACF acute care Support Service (RaSS) Document source Internal (QHEPS) and external Authorisation Executive Director, Healthcare Improvement Unit Keywords End of life, palliative, dying Relevant standards Aged Care Quality Standards:
Standard 1: consumer dignity and choice
Standard 2: ongoing assessments and planning with consumers
Standard 3: personal care and clinical care, particularly 3(c)
Standard 8: organisational governance, particularly 8(3)(e)