Background Anticipatory medications are regularly prescribed for subcutaneous administration to patients in their last weeks or days of life in order to relieve symptoms. Once prescribed, nurses are required to use their own judgment to assess the patient‘s need for medication. Although there is some literature reporting nursing experience in administration of anticipatory medicines in the community, information from the acute hospital setting is less well documented. We sought to explore awareness, knowledge and confidence of hospital nurses when administering as required (PRN) medicines for symptom control to dying patients.
Methods Semi-structured interviews were undertaken with qualified nurses. Purposive sampling was used targeting wards with higher death rates. An Interview guide was developed and piloted with the specialist Supportive and Palliative Care nursing team. Ethical approval was obtained. Interviews were audio-recorded, transcribed anonymously, coded and analysed using thematic analysis.
Results Ten interviews were conducted. Interviewees had been qualified between 1 and 10 years. Three main themes emerged from the interviews: education, nursing experience, and factors influencing nursing decision to administer PRN drugs. Newly qualified staff were less confident in administering PRN drugs, checking doses or questioning prescribing. Factors such as workload and family presence were recognised as influencing decisions to administer PRN drugs. Training, although provided regularly in the Trust, was considered difficult to access by the interviewees.
Conclusion In this large teaching hospital with a Supportive and Palliative Care team and an electronic prescribing system, although nurses interviewed were generally confident about administering PRN medication at end of life, this was dependent on their nursing experience. Most of the interviewees were able to identify the Supportive and Palliative Care team as their first point of call for advice. Further discussion with the specialist team following publication of the final report will determine how to address the identified issues.
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