Background Anticipatory prescribing is considered good practice in helping to ensure patients near the end of their lives are cared for promptly and in their chosen place of care. Practice varies, need for more agreement on prescribing (accepting prescriptions must also be individualised), may be of benefit. Determining a baseline of current practice sought.
Method 12 different palliative care institutes (hospices, hospital and community teams) were approached to seek information on their guidelines for prescribing anticipatory medication. Interest in which drugs are used for what symptoms, with doses, frequency ranges and maximum doses were requested in writing. Information on use of guidance for syringe pumps and use of patient information leaflets also requested (July 2019). Institutes were selected which tend to follow regional guidelines from the Specialist Palliative care Audit & Guidelines Group (SPAGG) and those out side this group to compare practices.
Results Generally agreement on which medications to prescribe with those outside the SPAGG area offering more choice on opioids and antiemetics. Only some centres routinely suggest anticipatory medication for dyspnoea. Less agreement on frequency of prescribing; mainly prn or 1 hourly but a considerable number of centres suggesting administration less frequently. Variable agreement on recommendation on maximum dose in 24/hrs for most drugs. Small number of centres advise on anticipatory syringe pumps, only 2 have leaflets to describe anticipatory prescribing.
Conclusions Those centres outside SPAGG give a range of medications for prescribers to choose from, SPAGG guidelines are quite specific. PRN prescribing guidelines recommend that a dose, frequency and maximum dose/no of doses in 24hrs are given; not all teams follow this practice. Agreement on how frequent doses should be given and suitable maximum daily ranges would be beneficial. Some teams give more advice relating to renal failure. Few teams routinely give a Patient Information leaflet- may benefit.
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