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19 Do patients with COVID-19 require different end of life medications? – The experiences of a dual site Hospital Palliative Care Team
  1. Lisa Boulstridge,
  2. Jillian Wall,
  3. Ruth England and
  4. Hannah Curtis
  1. University Hospitals of Derby and Burton


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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