Introduction: The purpose of this study was to evaluate the frequency of 5 common symptoms and drug treatments prescribed and given in the last 24 hours of life in 11 medical units at Landspitali National University Hospital of Iceland (LUH) and in 7 nursing homes (NH).

Material and methods: Data was collected retrospectively from 232 charts of patients who died in 2012, using documentation in the Liverpool Care Pathway (LCP) and the medication management system.

Results: About half of the patients died at LUH with similar gender ratio but 70% of patients in NH were women. The LCP was used for 50% of all deaths at LUH and 58% in NH. In 45% of all deaths LCP was used for 24 hours or less. The most common symptoms were pain (51%), agitation (36%) and respiratory tract secretions (36%). Frequency of symptoms was similar between institutions and age groups. Cancer patients had significantly higher incidence of agitation and were prescribed and given higher doses of morphine compared to other groups. Regular medication for agitation was haloperidol (45%), diazepam (40%) and midazolam (5%). Close to 70% of the patients were treated with a scopolamin patch for death rattle.

Conclusion: A large number of patients have symptoms in the last 24 hours of life both in hospital and in nursing homes. Symptom control can be improved by adjusting morphine doses to patients need, using regular doses of benzodiazepine for agitation and better use of anticholinergic medication for death rattle.

Figure I

Table I  Number of deceased patients at Landspitali University Hospital (LUH) and in nursing homes, age, gender, length of stay, main diagnosis and time on Liverpool Care Pathway (LCP) for the dying patient.

Table II Mean age and ratio of patients with symptoms at the last regular assessment scheduled before death at Landspitali University Hospital (LUH) and in nursing homes (NH), with cancer, non-cancer diagnosis and 80 years and older.

Table III Number of dying patients with regular doses of pain medication prescribed, as needed and given in the last 24 hours of life at Landspitali University Hospital (LUH), in nursing homes (NH), with cancer, non-cancer diseases and 80 years and older.

Table IV Number of dying patients with prescribed regular doses of medication for agitation, prescribed to be given as needed and/or given in the last 24 hours of life in Landspitali (LSH), at nursing homes (NH), with cancer, non-cancer diseases and 80 years and older.