COVID-19: NICE guidance on community and end of life care
NICE has published guidance on managing and treating the symptoms of COVID-19 in patients at home
COVID-19, the illness caused by coronavirus, has swept around the world since it was first identified in China late last year.
The pandemic in the UK has led to widespread restrictions to normal life in a bid to limit its spread and reduce the exposure of the most vulnerable. Community nurses will be caring for affected patients at home, including those who are at the end of their life.
The guidance sets out the importance of care planning and discussing possible likely outcomes so that patients can express their preferences about future treatment.
Nurses should find out if they have plans or advance decisions to refuse treatment, including do not attempt resuscitation decisions. The guidance also advises how to treat symptoms at home, recommending that people with a cough try honey before progressing to other treatment.
Signs and symptoms
Tell patients the key COVID-19 symptoms are cough, fever, breathlessness, anxiety, delirium and agitation, but that they may also have fatigue, muscle aches and headache, NICE says.
Causes and risk factors
While anyone can become seriously unwell from coronavirus, those considered high risk include those aged over 70, pregnant women and people with some conditions. Among those considered extremely vulnerable are people who have had solid organ transplants and people with some cancers, and those undergoing some cancer treatments, including chemotherapy. People with severe respiratory conditions including cystic fibrosis, severe asthma and severe COPD, people on immunosuppression therapies and pregnant women with heart disease are also considered extremely vulnerable, according to government guidance.
How you can help your patient
- Minimise face-to-face contact where possible.
- Support patient’s mental well-being, signposting to charities and support groups where available, to help alleviate any anxiety and fear they may have about COVID‑19.
- When possible, discuss the risks, benefits and possible likely outcomes of the treatment options with patients with COVID‑19, and their families and carers, so that they can express their preferences about their treatment and escalation plans.
- When managing key symptoms of COVID‑19 in the last hours and days of life, follow the relevant parts of the NICE guidance on care of dying adults in the last days of life. This includes pharmacological interventions and anticipatory prescribing.
- Be aware that severe breathlessness often causes anxiety, which can then increase breathlessness further. Advise patients that keeping the room cool, encouraging relaxation and breathing techniques, changing body positioning, and improving air circulation by opening windows or doors can help in managing breathlessness.
Julie Pearce, chief nurse and executive director of quality and caring services at Marie Curie UK
‘This guidance has been produced rapidly in a difficult, changing situation. Overall, I don’t think it will change the way that Marie Curie nurses approach work in people’s homes that much, as it describes things we already do, but it will be helpful to nurses in the community, including district nurses. The prescribing advice will also be useful for nurse prescribers and GPs.
‘One of the main changes emphasised in the document is doing more work remotely, on the phone where possible.
‘The NICE guidance acknowledges the shortages of medication and equipment, such as syringe drivers, we are likely to face, but does not say much about it. We are looking at different ways of delivering medication, such as buccal or subcutaneous, to deal with this.
'We are worried that people who are very unwell or approaching the end of life are using healthcare services less than normal. We want people to know we are still here for them and they should get in touch.’
Erin Dean is a health journalist
Find out more
- Greenhalgh T et al (2020) COVID-19 a remote assessment in primary care
- Marie Curie (2020) Coronavirus and end of life care
- Marie Curie (2020) End of life care during coronavirus
- National Institute for Health and Care Excellence (2020) COVID-19 rapid guideline: community-based care of patients with chronic obstructive pulmonary disease (COPD)
- National Institute for Health and Care Excellence (2020) COVID-19 rapid guideline: managing suspected or confirmed pneumonia in adults in the community
- National Institute for Health and Care Excellence (2020) COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community