Pre‐procedure

ActionRationale

1. 1.Show
   Consider and exclude any physiological issues that may be causing agitation (such as urinary retention, constipation or pain). Treat any issues identified; if agitation continues, consider this to be terminal agitation and continue to step 2.
   To ensure distress cannot be attributed to any other cause and to confirm it is terminal restlessness (Krakauer [76], C).
2. 2.Show
   Consider a single room if the patient is in hospital depending on the previous wishes of the patient.
   To ensure privacy and dignity is maintained and the ambience in the room remains peaceful (NICE [108], C).

   A single room may allow a family member to stay, and it may be reassuring for the patient to hear a familiar voice (Krakauer [76], C; Williams and Gardiner [165], P).
3. 3.Show
   Perform a mental capacity assessment and (if appropriate) make a best interest decision (see Chapter c05: Communication, psychological wellbeing and safeguarding).
   To ensure that the patient's capacity is assessed and documented and that any best interest decisions are clearly documented (NICE2018a, C).
4. 4.Show
   If appropriate, introduce yourself to the patient (if not then to their family). Explain and discuss the procedure and the need for terminal sedation with the patient and/or their family, and gain their consent to proceed. Discussions with the wider multidisciplinary team caring for the patient may also be necessary.
   To ensure the patient's wishes are met and to involve them in decision making and giving consent where possible (NMC [112], C). Clear communication with the family will also aid their understanding and acceptance (Krakauer [76], C).

Procedure

1. 5.Show
   Administer sedative medications as prescribed. Common medications include benzodiazepines (e.g. lorazepam, midazolam, clonazepam) and/or antipsychotics (e.g. levomepromazine, haloperidol, olanzapine). In deep sedation, medications such as phenobarbital and propofol may be considered by a specialist palliative care team.
   To ensure agitation is controlled as quickly as possible (Krakauer [76], C; Lacey [77], C).

Post‐procedure

1. 6.Show
   Evaluate the effectiveness of the medications and review the dose regularly.
   To implement adequate dosing to ensure patient comfort (Krakauer [76]; C, Lacey [77], C).