Background NICE guidance advises an ‘individualised approach’ to prescribing anticipatory medications including consideration of what medications are likely to be required depending on expected symptoms. We audited the prescription and administration of anticipatory medications (grouped into categories: benzodiazepines, opioids, anti-secretories and anti-emetics) in patients‘ last three days of life in three care settings.
Method A retrospective audit was undertaken and data collected for one month from Leeds Teaching Hospital Trust (n=132), St Gemma’s and Wheatfield’s Hospices (n=46) and Leeds Community Healthcare Trust (n=31). Hospital data was extracted from e-medication prescriptions from adult inpatient deaths excluding sudden deaths. Hospice staff completed a proforma for all deaths. All community deaths undergo a mortality review where expected deaths were identified.
Results Prescribing practice varied across settings. 100% of patients in hospices were prescribed all four medication categories. Prescription rates in hospital were lower and varied depending on drug group (benzodiazepine 49.2%, opioid 57.6%, anti-secretory 50% and anti-emetic 50.8%).
A small percentage of patients were administered drugs from all medication groups: hospice 17%, community 13% and hospital 4%. The number of patients administered drugs from each category varied across care setting but more patients required benzodiazepines and opioids compared to anti-secretories or anti-emetics.
Conclusion The use of anticipatory medication varies across care settings. This may be related to the average complexity of patient in each care setting. Universally there are trends in which groups of medications are used more/less often with opioids and benzodiazepines more commonly administered. Limitations include missing data and only recording medication use in the last three days of life; we will collect data for the last week of life in a repeat audit. Further community data is needed to guide a regional review including number of doses required and what medications were left at home following death.
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