Te Ara Whakapiri

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

Quick-reference documents for clinicians caring for patients in their last hours or days of life:

For Prescribers:

Anticipatory prescribing flow charts 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

For nurses/carers:

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 above)

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 (for any staff completing Te Ara Whakapiri documentation)

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

*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

Other reference and resource documents from the MOH

Te Ara Whakapiri: Principles and guidance for the last days of life (comprehensive background document from the Ministry of Health, 2017

Te Ara Whakapiri: Toolkit (the set of clinical checklists, flowcharts, tools and patient resources to be used for individual patients at the end of life from the Ministry of Health, 2017)

NOTE: some of the resources in this toolkit have subsequently been updated for the South Island and will therefor differ slightly from the MOH documents. See the links above

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)

Further information can be found on the Ministry of Health website: https://www.health.govt.nz/publication/te-ara-whakapiri-principles-and-guidance-last-days-life

Acknowledgments
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