Background In the light of the Gosport Independent Panel Report (June 2018), we conducted a comparison of continuous subcutaneous infusions (CSCI) at end of life in hospital and hospice settings.
Methods Retrospective case note review of all patients who died at a university teaching hospital and local hospice in April 2018.
Results 26/34(76%) hospice patients died on an infusion in comparison to 34/86(40%) hospital patients.
Select drug dose ranges were:
21/26(81%) had been on a regular opioid prior to starting an infusion in hospice, in comparison to 6/30(20%) in hospital.
Median survival after starting a CSCI: 3 days in hospice, 2 days in hospital.
Although recognition and discussion of dying was often recorded, documentation around starting a CSCI was poor in hospital. In the hospice, all patients had a documented indication and 24/26(92%) had a documented rationale for starting doses. While documentation of discussion with patients, family and between doctors was good, discussion with nursing staff was poorly documented in both settings.
Conclusions Higher drug doses used in the hospice setting could be attributed to more complex symptom control needs and interestingly did not seem to have a negative effect on survival. This comparative review highlights areas for improvement: documentation of discussion with family about starting a CSCI, indication and rationale for starting doses in hospital and documentation of discussion with the wider team in both settings. These are likely to apply to other hospices and hospitals.
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