Introduction Symptom assessment and management is one of the key areas in NICE guidance (NG31). The Gosport enquiry shone a spotlight on the use of continuous subcutaneous syringe pumps (CSCP) inparticular proportionate and appropriate use of opioids and other medications at the End of Life (EOL). In response to this report we conducted an audit of the use of CSCPs in our District General Hospital (DGH).
The audit had 2 aims;
To understand the frequency of use of CSCPs in adults recognised as dying,
To determine the average doses of medications in the last CSCP prescription prior to death.
Methods This was a retrospective audit. Data was collected alongside data collection for the National Audit of EOL Care 2019. A data collection tool was designed by the specialist palliative care team (SPCT) and results analysed in Excel. Thirty-five notes and drug charts of patients who died in April and May 2019 were reviewed.
Results 35 case notes were reviewed. The median age of patients recognised as dying was 83 years old (min 64, max 95). The 3 most common diagnoses were; cancer (24%), dementia (18%), respiratory disease (18%). Thirteen patients (37%) had a CSCP prescribed. Of these 12/13 (92%) contained an opioid; 6(50%) Morphine, 4 (33%) Alfentanil, and 2 (17%) Oxycodone. The mean subcutaneous morphine equivalent dose was 10.7 mg over 24 hours. Ten (77%) contained medication for agitation, the majority 9/10 (90%) contained Midazolam, with a mean 24 hours dose of 6.7 mg, and 6/13 (46%) contained Glycopyrronium.
Conclusion This audit shows that less than half of patients dying in hospital require a CSCP, and that average 24 hour doses were relatively low. The next step is to scrutinize the notes and symptom observations charts to determine whether objectively symptoms at the EOL were well controlled with these doses.
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