Management of the final 24 hours

The management of the final 24 hours of life of 100 patients, dying in Our Lady's Hospice is reviewed. This review suggests that management might be improved by better contact between general hospitals and hospice/home care teams concerning the timing of patient transfer. The frequency of symptoms in the dying patient, even where many are semi-comatose, is highlighted. The main distressing symptoms are pain, excessive respiratory secretions and agitation. Our review confirms reliance on standard palliative medications such as morphine, however identifies the benefit of such newer preparations as hydromorphone and midazolam. Management might be improved by the earlier usage of hyoscine subcutaneously and stopping the use of intramuscular diazepam. Attention to potential hyoscine toxicity and untreated pyrexia may ease pre-terminal agitation. The dying patient's family also needs attention to complete the optimal management of the final 24 hours.