Tips for Nurses:
End-of-Life Care Pathways

What it is: A care pathway is a tool which outlines what is recognised as best practice for a certain disease or condition with an expected course. A care pathway guides and monitors a person’s journey of best practice care between health professionals and across sectors. End-of-life care pathways can help prompt terminal care and encourage discussion with the person and their family.

Why it matters: Care pathways aim to:

prompt and guide clinical decisions
improve the timeliness of the start of care
improve the consistency of care between different professionals
reduce the risk of errors
prevent unnecessary emergency treatments
streamline care and therefore may reduce costs
give confidence that the right care is being provided.

For long-term or chronic conditions, care pathways can guide healthcare professionals on when and/or how to:

start treatment
follow-up
monitor change
check for and monitor complications
refer to other health professionals.

What I need to know: Care pathways differ from care plans. Care plans are based on the needs and preferences of an individual, and on the services available. Advance Care Directives should be included in planning.

Understanding the most common plans and pathways, and factors that influence these transitions can help medical practitioners and others to inform and advise older Australians who are:

about to start using aged care services
already using the aged care services.

Actions

End of life pathways guide terminal care. Recognising deterioration or signs of imminent death in the final days or weeks of life is critical.

Care pathways are based on available guidelines and evidence. They support clinical judgement but do not replace it.

When implementing a care pathway, remember to discuss it with the person and their family, and ensure that GPs and relevant staff are aware of this change. Discuss any changes or concerns and remember that a person can come off a pathway.

A care pathway represents the ideal way to manage people with a specific problem or longterm condition.

A care plan is based on the individual, and on the services available.

Care pathways use documents, sometimes flowcharts, to outline the steps of care to be followed by members of multidisciplinary teams.

Good communication within the care team and between the team and the person and their family is essential so that the person and the family understand the benefit of the care pathway.

Tools

Tools that may be useful include:

The Residential Aged Care End of Life Care Pathway (RAC EoLCP) – this tool guides the provision of good quality terminal care in residential aged care. It includes guidance on comprehensive planning, delivery, evaluation and documentation of terminal care.