Care planning
All people approaching the end of life need to have
- their needs assessed
- their wishes and preferences discussed
- an agreed set of actions reflecting the choices they make about
their care recorded in a care plan.
The care plan can include a person's general wishes and
preferences about how they are cared for and where they would wish
to die.
The care plan should be
- subject to review by the multidisciplinary team, the patient
and carers as and when a person's condition, or wishes, change
- available to all who have a legitimate reason to access
it.
Some people may also want to make an Advance Decision to Refuse
Treatment (ADRT)