Care of the dying: Setting standards for symptom control in the last 48 hours of life

The hospice model of care of the dying patient is regarded as a model of ex cellence; however outcomes of this care have been poorly demonstrated. Inte grated Care Pathways (ICPs) provide a method of recording and measuring out comes of care. The ICP document replaces all previous documentation and is a multiprofessional record of patient care. The aim of this study was to im plement an ICP in an inpatient hospice setting in order to set standards of care for symptom control in the dying phase of a patient's life. ICPs were analyzed from 168 inpatients who died over a one-year period. Symptoms of pain, agitation, and respiratory tract secretions (RTS) were monitored ever y four hours by nursing staff as either present or absent. For each symptom , 80% of patients had one episode or complete control of the symptom, 10% h ad two episodes, and 10% had three episodes or more recorded. As death near ed, there was a statistically significant increase in the number of patient s whose pain was controlled. The ICP has provided a means to measure sympto m control in the dying patient and set standards of care, which is integrat ed into clinical practice. (C) U.S. Cancer Pain Relief Committee, 2001.