Background It is well recognised that the off-label prescribing of medications is an essential part of practice in palliative care. ‘Off-label’ generally refers to a medicinal product that is used beyond the specification of its Marketing Authority. There are many reasons for the high incidence of such prescribing in palliative care including that the costly and time-intensive process of obtaining or expanding a licence can only be performed by a pharmaceutical company. Additionally, there is common use of subcutaneous medications, the majority of which are used off-label. While it is widely accepted as normal practice, there is a lack of standardisation regarding gaining informed consent from patients and its documentation.
Aim To gain information regarding the prevalence of off-label prescribing and address some of the issues that this presents.
Methods A retrospective study was conducted of the notes of patients referred to a HPCT over a 1 month period. All medications that were off-label (as determined by the Palliative Care Formulary, sixth edition and expert consensus) and recommended by the team were recorded including the drug, indication and route and whether by a HPCT consultant, doctor or Clinical Nurse Specialist (CNS).
Results 175 patients were referred. 541 drug recommendations were made, of which 266 (49%) were for off-label medications. The most commonly recommended off-label medications included opioids for breathlessness and levomepromazine for nausea and vomiting. All members of the HPCT made recommendations at a similar frequency.
Discussion By determining the prevalence of off-label prescribing, we have an understanding of the volume, patterns of drugs, doses and routes and doctor versus CNS variability. This will guide education of the HPCT, improve teaching throughout our Trust and inform the development of Patient Information documentation.
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