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Here is a one-page Emergency Department “End of Life Care Order Set” (UK NHS-style) designed for rapid use when a patient is identified as dying or entering last days of life.
🏥 ED END OF LIFE CARE ORDER SET (ADULT)
“Last Days of Life / Comfort Care Pathway”
1. CONFIRMATION & SENIOR REVIEW
☐ Senior clinician review completed
☐ Patient identified as likely dying (days–hours)
☐ Reversible causes considered and excluded where appropriate
☐ Palliative care team informed (if available)
2. COMMUNICATION & DECISIONS
☐ Patient capacity assessed
☐ Discussion with patient (if possible)
☐ Discussion with family/next of kin
☐ DNACPR completed and documented
☐ Treatment Escalation Plan (TEP) completed
☐ Preferred place of care documented
3. STOP NON-ESSENTIAL TREATMENT
☐ Cease routine blood tests
☐ Cease IV fluids (unless specific indication)
☐ Stop non-essential medications (preventive/chronic meds)
☐ Reduce monitoring (obs only if clinically indicated)
☐ Avoid burdensome interventions (scans, transfers unless comfort-related)
4. ANTICIPATORY SYMPTOM PRESCRIBING (PRN)
(Prescribe all unless contraindicated; adjust for renal function/opioid tolerance)
PAIN / DYSPNOEA
☐ Opioid PRN (e.g. morphine or alternative if renal impairment)
☐ Breakthrough dose prescribed (1/6th–1/10th total daily opioid equivalent)
AGITATION / ANXIETY / TERMINAL RESTLESSNESS
☐ Midazolam PRN SC/IV
NAUSEA / VOMITING
☐ Haloperidol PRN OR
☐ Levomepromazine PRN
RESPIRATORY SECRETIONS
☐ Glycopyrronium OR hyoscine butylbromide PRN
5. SYRINGE DRIVER (IF REQUIRED)
(Start if repeated PRN doses needed or persistent symptoms)
☐ Continuous subcutaneous infusion commenced
Typical combination (individualise):
Opioid (morphine/alternative)
Midazolam
Antiemetic (levomepromazine/haloperidol)
☐ Review dose within 4–24 hours
6. HYDRATION & NUTRITION
☐ Oral intake encouraged only if safe/comfortable
☐ Mouth care prescribed
☐ Consider stopping IV fluids if burdensome
☐ No artificial feeding unless exceptional indication
7. COMFORT CARE MEASURES
☐ Mouth care regimen prescribed
☐ Positioning for comfort
☐ Pressure area care
☐ Oxygen only if symptomatic benefit (not routine)
☐ Calm environment (reduce alarms/monitoring)
8. MONITORING
☐ Obs only if clinically indicated (comfort-based)
☐ Pain / distress assessed regularly
☐ PRN medication effectiveness reviewed
☐ Escalation to syringe driver if repeated PRN use
9. FAMILY / SUPPORT
☐ Family informed of expected trajectory
☐ Visiting facilitated (flexible/unrestricted if possible)
☐ Bereavement support information provided
☐ Spiritual care offered (chaplaincy if appropriate)
10. DOCUMENTATION
☐ EOL care plan completed in notes
☐ DNACPR visible in ED record
☐ Medication chart updated
☐ Handover to ward / hospice / community team completed
11. ESCALATION / CONSULTS
☐ Palliative care referral
☐ Hospice liaison (if appropriate)
☐ Out-of-hours GP/community palliative team (if discharge planned)
⚠️ KEY PRINCIPLE
Focus of care: comfort, dignity, symptom relief, and family support — not disease modification
If you want, I can convert this into:
a printable PDF order chart (ED drug box style)
a resus trolley “withdrawal of care” checklist
or a syringe driver titration guide (opioid + midazolam dosing table used in UK practice)
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