Background The Scottish Palliative Care Guidelines published in 2014 outline best-practice to support clinicians with end of life care. These guidelines include recommendations on anticipatory prescribing for patients nearing the end of life to allow these people to have timely access to injectable symptom control medication.
Aim To improve anticipatory prescribing in Hairmyres Hospital in line with Scottish national guidelines through evaluation of current practice and an educational programme for prescribers.
Method Inpatient medication prescription charts were reviewed and data analysed retrospectively. Inpatients referred to the hospital palliative care team for whom anticipatory prescribing was appropriate, over a four week period (n=20) were included. Data about patient demographics, anticipatory prescribing and subcutaneous infusions was collected. A teaching session on anticipatory prescribing was arranged for medical staff along with on-going case-by-case feedback and education from the palliative care team. Data was then collected in a further quality improvement cycle (n=12).
Results 60% (n=12/20) of patients were prescribed all recommended anticipatory medications. Of these, 77% of prescriptions were in accordance with the national guidelines (n=53/68). 71% of continuous subcutaenous infusions were prescribed correctly (n=5/7). Following the education programme, 67% (n=8/12) were prescribed all recommended anticipatory medications and of these, 86% of medications were prescribed in accordance with the guidelines (n=32/37). 100% of continuous subcutaneous infusions were prescribed correctly (n=6/6).
Conclusion This education programme improved the rate and accuracy of prescribing of anticipatory medication for patients nearing the end of life. More work is required to ensure awareness amongst prescribers of how and when to prescribe these medications with the aim of full compliance with the Scottish National Palliative Care Guidelines.
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