Background The End of Life (EoL) Care Strategy (2008) recommends that consistent ‘co-ordination of care’ and ‘delivery of high quality services in all locations’ is essential across a healthcare economy. Due to historical development and redesign of community services within a large healthcare economy in the north-west of England, we found ourselves with three different community policies for anticipatory medication at the EoL and five different prescription and authorisation forms. Cross-organisational collaborative working is essential to develop consistent standards that provide the high quality of EoL care and minimise potential risk.

Aim To assess the clinical impact of generic documentation for ‘Just in Case 4 Core Drugs’ (JiC4CD) anticipatory prescribing at the EoL across a healthcare economy.

Method A multi-disciplinary group of clinical experts from all the key stakeholder organisations within the healthcare economy reviewed the existing processes and documentation, and an ideal clinical pathway was agreed. A Task and Finish group designed and implemented new documentation in line with this pathway, including: • prescribing guidance • single prescription and authorisation booklet • JiC4CD pack (issued from community, hospital and hospice pharmacies) • audit form Audit forms were completed by the primary healthcare team and returned for analysis using simple statistical methodology.

Results The clinical impact of the JiC4CD booklet and pack was demonstrated with regard to: • EoL symptom control • prescribing and administration clinical incidents • crisis domiciliary visits and unplanned hospital admissions • place of death • carer satisfaction • healthcare professional satisfaction Facilitating factors and barriers to implementation will be discussed.

Conclusion Single generic documentation for JiC4CD anticipatory medications across a healthcare economy not only has a positive impact on individual patients, but the process also demonstrated benefits of cross-organisational partnership collaboration to achieve ‘high quality care for all adults at the EoL’.