The concept of “Just in Case” bags to support anticipatory prescribing in end of life care is not new, but there is little research evidence to support their use – anecdote and small audit level evidence at best. The recent 2015 NICE guidance on care of the dying patient highlighted the lack of evidence and specifically suggested more research into this topic.
In our rural community (population 380,000), “Just in Case” bags have been used in practice for many years. Over the last two years, it has been usual practice to dispense small supplies of “Just in Case” medication on discharge from our large, 75-bedded acute trust.
The usefulness of Just in Case bags is being reviewed in a number of ways:
Retrospective review of hospital and specialist palliative care records of a cohort of patients discharged over a six-month period with “Just in Case” medication
Attempts are being made to determine appropriateness, usage and effectiveness of symptom control
Estimation of costs
Preferred and actual place of death
Detailed review of patients prescribed “renal friendly” drugs - checking for appropriateness and effectiveness.
An analysis of problems associated with Just in Case bags will be undertaken and attempts to improve the process will be undertaken using quality improvement methodology.
The work is being developed by a team of junior doctors in the Trust, with the support of the specialist palliative care lead consultant and registrar. We also aim to show that by working closely with the lead prescribers of these medications (junior doctors) we can highlight the appropriate use and potential benefits of “Just in Case” bags in a more systematic way. At the same time we hope that this project will enhance more general awareness of end of life care beyond the acute hospital in this key group of staff.
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