Advance Care Planning – see Pro-active care for at risk patients
Guidance of death and certification – see the resources section.
General
- NICE guidance: COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community including guidance on managing cough, fever, breathlessness and delirium/anxiety/agitation (last updated October 2020)
- KHP Managing breathlessness at home during the COVID-19 outbreak leaflet for patients
- End of life care during COVID-19: London Clinical Networks Support Document. A comprehensive document signposting to multiple resources in London.
- British Geriatrics Society has a series of resources on End of Life Care in Frailty
- EOL/COVID-19 Guide including community palliative and bereavement care (RCGP). A guide to end of life care symptom control when a person is dying from COVID-19 (last updated March 2020)
- Helping break unwelcome news: HEE/HIN Resource Park. A set of materials and films to support staff through difficult conversations arising from COVID-19
Patient/family resources
- Macmillan Guidance for Patients with Cancer during COVID-19 pandemic
- What to expect when someone is dying – a leaflet for families/carers (GST)
- Videos to support end of life decisions (GST)
- Covid information for families (Mayor of London). Practical advice for family members when somebody has died.
Clinical resources, including borough-specific
- EOL care, advanced care planning, death notifications (Greenwich and Bexley)
- Lambeth: GP check-list for EOL care at home
- Care for a dying person community care plan (St.Christopher’s & GST). Includes detailed advice on symptom control, hydration, nutrition and other resources for the dying process.
Palliative Care Medicines
24-hour access to injectable symptom control medications for the adult dying patient in the community: Guy’s and St Thomas’ NHS Foundation Trust have provided the following guidance regarding the request of medications:
OUT-OF-HOURS (6.30 pm – 8 am Mon – Fri, 24 hours on Saturday, Sunday and bank Holidays).
For patients living in Lambeth, Southwark and Bromley
- Telephone the South East London Doctor’s Cooperative (SELDOC) on 020 8194 7594.
IN-HOURS – The GP should contact the community pharmacy to confirm injectable symptom control medications are in stock:
- 1st choice: The patient’s usual community pharmacy, then if stock not available,
- 2nd choice: One of the community pharmacies on the SEL palliative care drug access scheme. Contact details of nominated community pharmacies can be found below in section on Community pharmacies
- Palliative Care Guidance for management of COVID-19 in the community setting (GSTT)
- Process for the supply of end of life drugs by GSTT for Lambeth, Southwark and Bromley – one page summary
- Protocol for the supply of end of life drugs (out of hours) by GSTT for Lambeth, Southwark and Bromley
- BMJ Article on Palliative Care for patients with severe Covid-19
- Guidance on symptoms control: London clinical network
- Symptom control advice last few days of life (GST). A comprehensive document if you need specific detailed information
- Guidance for carers to administer s/c medications
Resources from the NHS England Hosted Pan- London MAAR chart Webinar
Information on Pharmacies commissioned to hold palliative care injectable stock
Hospices
St Christopher’s: open to referrals as usual for both their community offer and inpatient unit. Accepting referrals 7 days a week and continue to accept Covid+ patients. Please refer in the usual way by calling 020 8768 4500 (24 hrs a day) or email a referral form.
- For emergency referrals please call the number provided above.
- St Christopher’s have launched an online wellbeing programme
- Professional advice please call 020 8768 4582 rather than use the central number.
- St Christopher’s have developed a suite of documents to support you to manage people reaching the end of life and a series of webinars, bitesize sessions and on demand courses – includes verification or death to advance care planning.
Resuscitation
Compression only CPR with patients mouth and nose covered in cloth. Safe to use defibrillator.
- SEL CAG have produced a Statement of Best Practice covering documentation of DNACPR (do not attempt cardiopulmonary resuscitation) decisions in out of hospital settings.
- DNACPR form . Also available when you complete a CMC update – see Advance care planning for CMC details