Home › Conditions › End-of-Life Symptom Control
palliative
End-of-Life Symptom Control
Recognising dying pivots care to comfort: stop non-beneficial interventions, prescribe the four anticipatory SC medicines, start a syringe driver when PRNs repeat, and treat the family's distress with honest communication. Mouth care, secretions…
Care of the Dying Pathway
The pathway
1 · Recognise & communicate
- Bed-bound, ↓consciousness, no intake, Cheyne-Stokes
- Senior confirmation
- Tell the family clearly and kindly
2 · Rationalise
- Stop obs, bloods, non-comfort drugs
- Deactivate ICDs
- Continue what comforts
3 · Anticipatory medicines
- Morphine 2.5–5mg SC PRN (pain/dyspnoea)
- Midazolam 2.5–5mg SC PRN (agitation)
- Glycopyrronium 200mcg SC PRN (secretions)
- Levomepromazine 2.5–6.25mg SC PRN (nausea)
4 · Syringe driver
- ≥2–3 PRNs/24h → CSCI at summed dose
- PRN = 1/6th of 24h opioid
- Review + uptitrate daily
5 · Active comfort care
- Mouth care (involve family)
- Reposition for secretions; bladder scan for agitation
- Skin, eyes, bowels, spiritual needs
6 · After death
- Verification, sensitive certification
- Bereavement support + information
- Debrief the team when needed
Drugs
| Drug | Dose | Route | Notes |
|---|---|---|---|
| Morphine | 2.5–5mg SC PRN (opioid-naive) | SC | Pain + breathlessness. Driver when repeated. |
| Midazolam | 2.5–5mg SC PRN | SC | Agitation/distress. Exclude retention first. |
| Glycopyrronium | 200mcg SC PRN | SC | Secretions — no CNS penetration, works best early. |
| Levomepromazine | 2.5–6.25mg SC PRN | SC | Broad-spectrum antiemetic; higher doses sedate — useful in refractory agitation. |
When to escalate
Symptoms refractory to anticipatory doses — palliative care team,Massive haemorrhage/airway event risk — crisis medication plan,Family conflict or distress needing senior conversation,Uncertainty whether dying — senior review; recognition can be wrong both ways
Reference: NICE NG31 Care of the Dying Adult / Priorities for Care framework
This page is the reference half
The app adds what a web page cannot: a VINDICATE differential builder, worked on-call scenarios with full A–E findings, recall practice, and all of it offline.