Te Ara Whakapiri

Te Ara Whakapiri (the unifying path): Principles and guidance for the last days of life

Note: If you have access to the Waitaha Canterbury Intranet/SharePoint, this is the best place to find localised content.

End of Life Care and Bereavement – Te Ara Whakapiri

If you do not have access to the Waitaha Canterbury Intranet/SharePoint here are quick-reference documents for clinicians caring for patients in their last hours or days of life across the South Island:

For All Staff:

Baseline assessment and preparation for care after death (checklist)

Symptom management in the last days of life (guidelines including holistic care recommendations and the anticipatory prescribing flow charts, as below)

Discharge checklist (when someone is being discharged home to die)

For Nurses/Carers:

Ongoing care of the dying person – hospital setting (ACE chart to be completed each shift)

Ongoing care of the dying person – home setting (ACE chart to be completed each visit)

Staff signature sheet (only for staff using the paper versions of Te Ara Whakapiri)

Anticipatory prescribing flow charts (for prescribers):

for the five most common symptoms (what medications to prescribe and when/how to use them)

Pain Management Flowchart

Pain (with renal impairment)

Dyspnoea/breathlessness

Agitation/delirium/restlessness

Nausea/vomiting

Excessive respiratory tract secretions

Note: these documents were adapted from Te Ara Whakapiri: Principles and guidance for the last days of life (Ministry of Health, 2017) by the South Island Te Ara Whakapiri Workgroup, South Island Alliance, 2020

National Te Ara Whakapiri documents

The comprehensive background document and the Toolkit (Ministry of Health, 2017) are located for reference on the Health New Zealand website. The Toolkit includes clinical checklists, flowcharts, tools and patient resources some of which were updated for the South Island (as per links above).

Te Ara Whakapiri – Te Whatu Ora

The links below are to the original national documents within the MOH/HNZ Toolkit.

Recognising the dying person (flow chart)

Medical management planning (general principles)

When death approaches (information sheet for carers)

Dying at home (information sheet for carers)

Bereavement risk assessment tool (checklist for staff)

Acknowledgements

Many thanks to the original MOH team for developing these Te Ara Whakapiri resources, as well as Dr Kate Grundy and the South Island Te Ara Whakapiri Workgroup who subsequently refreshed several of the documents.

South Island Te Ara Whakapiri Workgroup

Dr Kate Grundy (Chair), Jo Hathaway (Facilitator), Rose Blair, Steph Ash, Vicki Telford, Sinead Blee, Annie Wallace, Amanda Jennings, Nicky Featherstone, Jane Smith, Dr Louise Bremer, Sharon Stewart