Background Controlled drugs (CDs) such as opioids and midazolam are commonly used in end-of-life care symptom management for care home residents.
Aim To review the published evidence concerning the prescribing, storage, use and disposal of CDs for end-of-life care for care home residents in the UK.
Design Systematic review and narrative synthesis.
Methods Seven databases (Medline, CINAHL, Embase, PsycINFO, Web of Science, Cochrane Library, and Social Care Online) were searched from January 2000 to January 2021, alongside reference, citation and journal hand searches. Gough’s ‘Weight of Evidence’ framework was used to appraise the relevance of studies to the review questions.
Results The search yielded 1279 titles, from which 125 abstracts and then 42 full-text papers were screened. 14 papers were included in the synthesis. Prescribing is primarily by general practitioners, with administration by nurses. Nurses frequently report feeling inadequately trained in the use of CDs. The storage, monitoring and disposal of end-of-life care CDs in UK care homes has not been researched to date. The attitudes and experiences of residents and family members regarding these medications also remain unknown.
Conclusion The current widespread use of CDs for end-of-life care in care homes has a limited evidence base. The lack of research concerning the storing, monitoring and disposing of CDs, alongside the limited evidence concerning resident and family members’ perspectives, is a significant knowledge deficit that requires urgent attention.
PROSPERO registration number CRD42020173014.
- terminal care
- symptoms and symptom management
- nursing home care
- clinical decisions
Data availability statement
Data are available in a public, open access repository.
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Twitter @megmajumder, @Ben_Bowers__, @ilk21
Contributors MM, BB, SB, KP, CG and IK contributed to the design and implementation of the research. MM (guarantor), BB, SB, KP and CG contributed to the analysis of the results and to the writing and editing of the manuscript.
Funding MM is funded by the Abbeyfield Foundation (Grant No 23), which has funded this research. SB and CG are supported by the National Institute for Health Research (NIHR) Applied Research Collaboration East of England (ARC EoE) programme. BB is funded by the NIHR School for Primary Care Research.
Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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