Monitoring symptoms and comfort in the last days of life

While it is appropriate to stop measuring vital signs in the last days of life, it is important to monitor patients for comfort and signs of distress related to symptoms that commonly occur. Comfort monitoring involves regularly assessingClinical Excellence Commission (CEC), 2012:

• pain
• altered breathing patterns, including breathlessness causing distress and excessive respiratory secretions
• nausea or vomiting
• agitation and restlessness
• urinary comfort
• bowel movements
• skin integrity and cleanliness
• cleanliness and moistness of eyes, lips and mouth
• if spiritual and cultural needs are met
• for distress in families and carers.

Patients are generally poorly responsive or unconscious in the last days of life; monitoring and assessment are based on signs such as facial expression, movement, vocalisations, body posture and changes in breathing.