A good life to the very end…

Chief Pharmacist and Clinical Director of Pharmacy and Medicines management for Cardiff and Vale University Health Board
Darell Baker, Chief Pharmacist and Clinical Director of Pharmacy and Medicines management for Cardiff and Vale University Health Board

by Darrell Baker FFRPS, Chief Pharmacist and Clinical Director of Pharmacy and Medicines management for Cardiff and Vale University Health Board

A good life to the very end…

For human beings, life is meaningful because it is a story, and in stories endings matter
(Atul Gawande)

Quality palliative and end of life care is important and medicines can have a key role to play in facilitating that quality of care for many of our patients. On behalf of the Chief Pharmacists in NHS Wales, I am pleased to have supported the development of the RPS Wales policy document and to endorse its key recommendations.


Focusing on the individual

Understanding what quality end of life care looks (and feels) like for an individual is an important starting point. Pharmacy staff need to work as integrated members of the multi-professional team around the patient, with access to clinical information about the patient. This way, we are able to respect their wishes and support effective implementation of treatment and symptom management plans, regardless of location.

Pharmacy professionals need a sound therapeutics knowledge base, competence and the confidence to effectively consider and address the needs of the individual (the essence of “care”). Addressing the main concerns of the patient and their carers is paramount. That may relate to the fear and anxiety about what is happening and how quickly it might happen, or worries over the effectiveness of pain relief or ability to overcome other symptoms.

Effective communication and support across all care settings is vital, with access to specialist advice when required.


Getting the basics right

The fundamental principles of effective pain management and symptom control are the bedrock of education and training in palliative care. These are not “rocket science” and have been taught to the pharmacy workforce over many years. I had the privilege of working with Professor Ilora Finlay (Baroness Finlay of Llandaff) when I first came to Cardiff, and still remember her strong message that dying in pain does NOT (and should not) have to happen. She is right to signal that we have the ability to do end of life care far better than we (sometimes) do.

Professor Finlay has been supportive of the role that pharmacy teams can have in working with others to provide effective symptom management, timely access to pain relief and personalised and clear care plans for everyone. She was always also quick to remind us about the impact of not getting it right for the family, friends and carers who live with the memory of this bad experience forever.

The pharmacy team must do whatever it can to avoid that bad experience, whether that is ensuring safe and timely access to medicines for symptom relief, providing reassurance as and when it is appropriate and supporting patient (and carer) empowerment to articulate what matters most to them at what can be a very challenging time.

We all have a responsibility to ensure ourselves, our staff and our systems are up to the challenge. We must continuously improve the quality of care provided throughout life, with the Health and Social care plan for a Healthier Wales setting out how this might be achieved.  Nowhere is this improvement more important than at the end of life. We need to assume collective responsibility to deliver the key recommendations set out in this policy and ensure highest quality care … until the last chapter.

“Our ultimate goal, after all, is not a good death but a good life to the very end”   (Atul Gawande)

Darrell Baker is part of the RPS Wales Palliative Care Policy Steering Group . Our new Palliative and End of Life Care policy for Wales will be published at the end of November, and launched at the RPS Medicines Safety Conference in Cardiff on November 22.

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