Background and Aims At the end of life, a person’s needs and goals change. It is, therefore, important to review medications to ensure optimum symptom control and to deprescribe unnecessary treatment. The aim of the study was to assess the impact of Specialist Palliative Care (SPC) review on reducing polypharmacy and prescribing anticipatory symptom control medication in inpatients at the end of life.
Methodology Adult inpatient deaths between July 2018 and February 2019 in an acute London Hospital were identified. Deaths in Intensive Care Unit and within 24 hours of admission were excluded. Demographic data, medication name and number on admission, at death and which were discontinued, were collected. Evidence of a SPC review and prescription for anticipatory medication were recorded. Using SPSS software, Chi Squared and Mann Whitney U tests were performed to identify statistical differences in prescribing for patients who had been reviewed by SPC.
Results 201 patients were identified. 159 patients (79%) were reviewed by SPC, a median of 5 days prior to death (interquartile range 2–11 days). Significantly more medications were discontinued in those who were reviewed by SPC (6.4 medications per patient) than those who were not reviewed (4.2 medications per patient, <0.001). 179 patients (89%) were prescribed anticipatory medications. Of those reviewed by SPC, 158 (99%) were prescribed these medications, therefore a SPC review made anticipatory medication prescription significantly more likely (<0.001).
Conclusion SPC review reduced polypharmacy at the end of life and also increased the likelihood of anticipatory medication prescription. However, this mostly occurred only a few days prior to death. There needs to be continued focus on early identification of patients nearing end of life and medication review to enable appropriate deprescribing. Further research needs to determine whether deprescribing improves quality of life.
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