Page 25 - TERMINAL DISCHARGE GUIDELINE FIRST EDITION 2023

Chapter 7
Terminal Discharge Pathway

Signs of imminent death

Physical Signs

1. Cool peripheries and or peripheral cyanosis
2. Skin mottling

3. Weak pulses
4. Fluctuating Consciousness/Delirium
5. Change in Breathing Patterns: Apnoea periods, Cheyne-Stokes

Breathing
6. Death rattle: gurgling sounds produced during breathing due to
airway secretions
7. Respiration with mandibular movements

8. Reduced urine output: less than 100ml over 12 hours
9. Dysphagia of liquids

Once decision for terminal discharge is made, the doctor (Consultant,

Specialist or Medical Officer) will prescribe the medication which will be
screened by the ward pharmacist. The staff nurse will then use the
medication from the imprest stock or collect from the inpatient pharmacy

and prepare the subcutaneous injections. All the medication prepared will
be counter-checked by pharmacist.

The administration of sublingual, subcutaneous and transdermal
medication will be demonstrated and educated by staff nurse and/or
pharmacist to the caregiver which includes indication, dose, route, interval,
refill, and disposal of medication. The documentation (toolkit) will then be

completed according to checklist.

The patient will also be referred to Hospice or Domiciliary service for
community palliative care services. If the area does not have hospice nor
domiciliary coverage, then the patient will be followed up by primary team
or the palliative care team.

HOSPITAL KUALA LUMPUR 25
TERMINAL DISCHARGE GUIDELINE 2023