Nts resolved in discussion.Results Nine deaths occurred in the care properties after a period of planned endoflife care `anticipated dying’.Three deaths occurred in PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/21439719 the care houses following an unexpected acute illness or sudden event `unexpected dying’.Seven deaths occurred in hospital following a period of diagnostic uncertainty or difficult symptom management that had led to hospital admission `uncertain dying’.4 deaths occurred in hospital after an unexpected acute occasion inside the care residence that had precipitated hospital admission `unpredictable dying’.Anticipated dying Records analysis for the nine residents within the `anticipated dying’ category indicated that they had been recognised as approaching the end of their lives some time prior to death, with their dying phase and death managed within the care house.There was documentation of progressive physical deterioration, a focus on `tender loving care’, commencement of the LCP, or setting upBritish Journal of General Practice, September Cyanine3 NHS ester SDS eAnticipated dying Death within the care household with anticipated and planned endoflife care n Selection produced for palliative careUncertain dying Death in hospital following a time of diagnostic uncertainty or complicated symptom management n Choice created to admit to hospitalhospital admission Death DeathUnexpected dying Death in the care property following an unexpected acute illness or sudden event n Acute illnessevent instantly prior to deathUnpredicted dying Death in hospital soon after an unpredicted event n Acute eventhospital admission Death DeathFigure .Trajectories to death in residential care residences in the course of the final month of life.Figure .Patient in `anticipated dying’ category.DN district nurse.TLC tender loving care.Anticipated dying Bring about of death Cancer Spot of death Care home Preferred location of care Care homea syringe driver for subcutaneous drug administration.Three of those residents had cancer, 3 lived with dementia, and all died in the care residence.Pain was recorded as a symptom for six persons, andover a prolonged time frame for 3 folks.Figure illustrates one example of a patient whose death was anticipated.The resident was discharged from hospitalDischarged from hospital days previously for palliative nursing.Advance Care Plan completed GP changed haloperidol time, to overview in weeksGP nausea, vomiting, agitation, restless, discomfort, respiratory tract secretions, conscious.Began LCP Syringe driver startedLevomepromazine hours.Medication prescribed as requiredDN abdominal discomfort, arranged for paracetamol PRGP midazolam mg added to syringe driver.Family members present at deathDN no restlessness or agitationGP midazolam added to syringe driverDays before death Sat out in garden with yet another resident Ate and drank a little bit Pain on movement, PR paracetamol, Unsettled, TLC, mouthcareAll TLC given Bright when speaking, has been sickVery confused, needing painkillers, feeling sick Refused painkillersNo discomfort, sick when taking medicines consuming tiny amountsFeeling sick, poorly, very tired, coughing up phlegmMore poorly complete help two carers to transfer, unable to swallow to talk about with GPSettled overnight, choking when consuming, mouthcare, carer sat with resident, DN calledPoorly, agitated, uncomfortable, talked to and created comfortable Incredibly poorly, back sore, Slightly unsettled, agitated, rectal paracetamol, position changed, loose bowels, mouth care black in coloure British Journal of Basic Practice, SeptemberUnexpected dying Lead to of death Pneumonia Location of de.
