Background In the UK, a key approach to improving symptom control in end of life care in the community has been the use of ‘anticipatory’ or ‘just in case’ prescriptions. There is almost no research on nurses' roles in this area.
Aim To determine the roles and experiences of community nurses in end of life medication decisions involving anticipatory prescriptions.
Methodology A mixed methods study in two UK regions. An ethnographic study was conducted with community nursing teams (4) and in nursing homes (4), engaging health care professionals involved in prescribing, issuing and using anticipatory medications. In addition, 1558 community nurses were surveyed.
Results Observations (n=83) and interviews (n=72) were conducted with nurses, GPs and pharmacists. The overall response rate to the survey was 37% (n=574), with categories of nurses' response as follows: community (n=192/25%), care home (n=231/50%), specialist palliative care (n=151/48%). 84% of nurses reported having provided care to adult patients who were dying during the past year. 98% of these said that an anticipatory prescription was in place for at least one of those patients. Nurses took a key role in prompting GPs to consider anticipatory prescriptions, encouraging them to write prescriptions correctly and enabling timely dispensing. They took responsibility for recognising the need to implement the prescription and administering the medications. Most respondents (96%) agreed that when anticipatory prescriptions were in place they enabled them to improve the quality of end-of life care. However, nurses with less experience often found their responsibilities burdensome. Nurses were concerned about ‘over’ and ‘under’ medicating patients and using medication at the ‘right time’.
Conclusions This study highlights the significant responsibilities of nurses in all aspects of the anticipatory prescribing process and identifies a number of areas where support for nurses could be improved to promote quality care at end of life care in community settings.
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