Case study:

11 May 2010

Improving symptom control at the end of life in Conwy

Key points

Care of the dying in a Conwy care home (nursing and personal care) has improved ‘beyond recognition’ following the introduction of the community care pathway for the last days of life.

The new pathway has been in place for two years and has led to 90% of residents ending their days in the Cartfef Brynn-Yr-Eglwys care home with good symptom control and their wishes respected.

The other 8% died in acute hospitals following long illnesses and just 2% died suddenly or unexpectedly in the care home.

The decision to introduce the care of the dying element of the Liverpool Care Pathway followed a distressing incident two years ago when an elderly resident died in some pain and discomfort after the out-of-hours GP service failed to attend to alleviate her symptoms.

Before the pathway was introduced, registered nurses received in-house training from the community Macmillan nurse as well as a study afternoon on the use of syringe drivers and good symptom control.

Local GPs also agreed to employ the new tool.

The new approach has made a significant difference to the care of the dying, with residents now experiencing a more dignified and peaceful end to their lives.

However, some staff still find it difficult to know when to stop striving to keep a person alive and to accept that death is approaching and therefore adapt their care to management of symptoms alone.