Background Requesting of anticipatory medications (AM) for the use at end of life is common practice for patients known to community palliative care services. The aim of this practice is to ensure prompt management of symptoms to achieve a good death, and to prevent unwanted transfers to hospital or hospice. There is little in the way of guidance to help clinicians determine the optimum time for requesting AM, and it is often reliant on clinician intuition.
Aim To understand the current practice of prescribing AM for the population of patients under community palliative care services, and examine whether local guidelines could be established.
Design A retrospective notes review was undertaken examining the patient records of 150 consecutive deaths.
Findings There were 100 cancer patients and 50 Non-cancer patients in the cohort. 94 (63%) of all patients had AM prescribed at time of death vs. 56 (37%) who did not. A higher proportion of non-cancer patients died with AM: 39/50; when compared to the cancer cohort 55/100. A higher proportion of the patients who achieved their PPD had AM: 74/97. The average time from request of AM to death was 55 days (mean) and 18 days (median).
Conclusion As there are no local guidelines or standard, it is not currently possible to audit the practice of requesting AM. Further work is needed to develop a guideline including triggers for conditions which indicate the need for AM, and future practice can then be audited against this standard.
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