Introduction University Hospitals of Derby and Burton (UHDB) report our Hospital Palliative Care Team’s (HPCT) experience in supporting patients with COVID-19 during the pandemic’s first surge.
Methods Inclusion criteria: patients supported by HPCT at two acute hospital sites, with a positive RT-PCR nasopharyngeal swab for SARS-CoV-2 between 16th March and 1st May 2020. Exclusion criteria: Patients intubated on ITU. Data was extracted from medical and nursing notes retrospectively and prescriptions in the last 3 days of life were reviewed. We sought to describe the cohort of COVID-19 patients supported by HPCT and to evaluate their medication requirements at end of life.
Results 223 patients were referred to HPCT: 155 (70%) with a positive swab for SARS-CoV-2. 95% had never been seen by HPCT previously. On average they had had one hospital admission in the preceding 12 months (range 1–8). The proportion of non-white patients was higher than our usual cohort (7 vs 4.6%). Whilst receiving input from HPCT 112 (72%) patients died in hospital and only 4% were discharged from hospital. All patients had anticipatory medications prescribed during their last 3 days of life; 41% required at least one dose in the 2 days before death, and 62% on the day of death. On the day of death, 59% required a dose of an opiate, 60% midazolam and 20% an antipsychotic; 72% had a syringe driver in place. However 23% required no anticipatory medications or a syringe driver. Doses of drugs given did not exceed those typically used in non-COVID patients.
Conclusions The vast majority of patients during this period of time were new referrals to HPCT. In line with other published work, most patients dying with COVID-19 had symptoms which were managed with usual doses of medications. An opiate and midazolam were the drugs most frequently required.
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