At the end of life, it is important to review all medications, and those required may be continued via a syringe driver if the person is unable to take them orally. The anticipation of needs and forward planning are important, having medications and resources available, ensuring all service providers are aware of the patient 24 hours a day and families have relevant contact numbers. Effective communication with the patient and family is essential, to manage expectations and ensure they understand what is being done and why. Care should always be planned in accordance with local and national guidelines in best practice in palliative and end-of-life care. Anticipatory prescribing of as-required medications for symptoms can help avoid distress. Respiratory secretions (death rattle) can cause noisy, rattling breathing that occurs when the dying person is unconscious and close to death and is unable to cough or clear secretions. This can be distressing to family members, and they will need support and information about the condition. Nursing care involves repositioning to aid drainage of secretions, frequent mouth care, and review of fluid input, and drugs may be used to reduce secretions. Terminal agitation is a state of agitation and distress at the end of life. This is a distressing experience, and it is most important to communicate effectively with the patient and family, maintaining dignity and privacy and providing a comforting professional presence. Sedation should be used with care and discretion, taking the wishes of the patient and family into account.
92 An audit of current guidelines and recommendations for mouth care in palliative and end of life care
