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Abstract
‘Noisy breathing’ also known as death rattle, is common in end of life care situations and can be distressing for the family given it's unpleasant resonance. A recent Cochrane review by Wee et al (2009 review) concluded that there is no evidence to show any intervention was superior to placebo; it is very difficult to subsequently manage.
Aim To evaluate current practice against national guidelines on the use of antisecretory medications in end of life care.
Methodology Retrospective, case notes review of all the patients died in the author's unit (Jan 2011–May 2011).
Results Seventy-two patients were identified with 65 patients having antisecretory drugs prescribed and 36 patients requiring medications. 49/65 had complied with the recommended guidance with only 29/36 having a documentation of a response. 7/36 patients with no documentation of assessment. 24/29 patients had documented benefit from the antisecretory drug and a syringe driver started in 24/36 cases. Apart from drugs evidence of other modalities used was lacking: 3/36 patients evidence of re-positioning only. Documentation of communication with family was only in 4/36. 22/36 patients died within 48 h from 1st dose of antisecretory given and 16/24 patients died within 24 h of the syringe driver starting.
Conclusion In a majority of patients medications used appropriately and response assessment completed. However, documentation of communication with family and other approaches needs to be improved. Interestingly when antisecretory drugs were used death ensued within 48 hrs for the majority. Education of all staff members is extremely important along with regular audit.