Background Anticipatory prescribing and use of syringe drivers at end of life is now established practice. A national report outlined the need to ensure safe, appropriate and individualised prescribing for patients at end of life, considering available guidance to aid decision making. Within our locality we deemed it vital to demonstrate we are complying with guidance.
Aims To ensure safe and effective care of patients at end of life, with an individualised approach to decisions and compliance with guidelines, policies and procedures.
Methods Questions were developed through collaborative discussion and data collection tool produced. Retrospective audit cross settings was undertaken based on place of death to avoid duplication.
Results 71 cases included for full analysis. Largest proportion in Hospice. Spread of gender, age, diagnosis. Substantial data was collected on core drugs at end of life. Using agitation as an example, 93% had an individualised approach to prescribing: all had a dose and route; 1 no frequency although this was felt to be a documentation error; 31% had a maximum dose; 93% had an appropriate dose adjustment for renal impairment. In the last 24 hours of life the total dose of midazolam: Hospice median 1.25 mg and mean 8.2 mg; hospital 0 mg and 1.7 mg and community 0 mg and 5 mg respectively. Similar results were found for other drugs in terms of quality of prescriptions and individualised nature of decision making.
Conclusion Individualised approach to prescribing was evident overall, with a high standard of prescribing. Some incomplete prescription although felt due to data collection errors. Doses of medications in line with network guidelines. Need to improve discussion with patients and families regarding medications, syringe drivers and side effects. The three organisations involved developed individual action plans including improvements in documentation and where electronic prescribing had commenced, embedding this.
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