The patient’s condition is deteriorating and death could occur in the next few hours, days or weeks

Level 2: The patient’s condition is deteriorating. Symptoms

worsening over weeks.There are new but expected

problems.Prognosis is likely to be weeks.

Level 3: The patient’s condition is unstable.

Symptoms may worsen quickly requiring regular monitoring/medication

changes. Prognosis is likely to be days to weeks.

Level 4: The patient’s

condition is deteriorating

rapidly. Prognosis is likely to be

days to hours.

Discharge using the RIPPLE Pathway, aiming for a discharge within 24 hours of

commencement of RIPPLE pathway.CHC Fast Track completed by DN after

discharge.

Discharge using the RIPPLE Pathway, aiming for a discharge within 6 hours of

commencement of RIPPLE pathway. CHC Fast Track completed by DN after

discharge.

Discharge remains the responsibility of the nursing teamFor support with the process,

contact Capacity Team and Sally Prytherch, Practice Development Nurse for End of Life Care

RIPPLE Pathway: Realising Individual Patient Preferences at Life's End

RIPPLE Pathway: Realising Individual Patient Preferences at Life's End

Level 1: Patient condition is stable. Symptoms are well-controlledMobile, could leave home with

assistance. Could receive care in a supportive environment other than home- e.g. day hospice,

respite interventions.

Patient and family are aware of the uncertainty of the prognosis and home is the preferred place of care for the patient and carer at this time

Refer for routine discharge with

support from social services or CHC as

appropriate

Reversible causes have been considered by the team(including opioid toxicity, renal failure, hypercalcaemia, infection, hypoxia, hypoglycaemia, hyperglycaemia, hyponatraeamia etc)

Complete the Prioritisation tool (see page 5 of the RIPPLE Pathway)