• Clinical assessment
• End of life care
• Hospital care
• Symptoms and symptom management

Studies examining the prevalence of symptoms experienced by patients in the last hours to days of life have been conducted predominantly in hospice and care home settings, with a paucity of studies focused on patients dying in acute hospitals.1 Furthermore, the studies which have taken place in acute hospitals have focused on disease-specific cohorts.2 In the UK, a significant proportion of deaths occur in acute hospitals with variability in quality of care provided to dying patients.3

In 2018, a quality improvement initiative was developed within our Trust to enhance care for patients at the end of life by embedding an approach to individualised care planning and regular proactive symptom assessment. This included the implementation of a ‘Guide to Individualised Care Planning’, framed around the five priorities for care of the dying person, employed in combination with an adapted (permissions obtained) ‘symptom observation chart’ (SOC).4

The SOC encourages 4 hourly symptom monitoring for adult inpatients recognised as being in the last hours to days of life, and prompts more frequent observations when symptoms persist. It also facilitates the documentation of decisions taken around managing symptoms, and sets a standard for seeking senior support.

When used, the SOC prompts staff to assess symptoms of agitation, breathlessness, dry mouth, nausea, pain, respiratory secretions every 4 hours …