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33 Getting palliative medications right: intended processes for home, hospital and hospice
  1. Sarah Yardley1,2,
  2. Sally-Anne Francis1,
  3. Bryony Dean Franklin1,
  4. Margaret Ogden3,
  5. Joseph Elyan4,
  6. Karen Mattick5 and
  7. Anu Kajamaa6
  1. 1University College London, UK
  2. 2Central and North West London NHS Foundation Trust, UK
  3. 3Patient and Public Involvement Co-Investigator
  4. 4Barking, Havering and Redbridge NHS Trust, UK
  5. 5University of Exeter, UK
  6. 6University of Helsinki, Finland


Introduction Palliative medication management is a complex multi-step process. Whole system coordination enacted through professionals, patients and carers is needed but specialist support varies in quality and availability, with deficits common. Transitions between healthcare settings and teams are especially high-risk.

Aims To develop a visual model of intended processes for home, hospital and hospice, identifying gaps in evidence and understanding from multiple perspectives.

Method Phase one of this study develops an intended processes model for how palliative medicines management should work. A stakeholder engagement exercise (thematic analysis of 21 remote informal conversations around known steps in medication management) orientated and underpinned a scoping review of academic studies and grey literature (organisational flowcharts and policies) using Joanna Briggs Institute methodology. Both were synthesised to produce a visual model of ‘work-as-imagined’ to get palliative medication management right regardless of care setting.

Results Our model maps existing evidence of intended processes and practices when palliative medications for symptom control are prescribed and used at home, in hospital and hospice. The model of intended processes will be presented, demonstrating that processes are not linear, and feedback loops are required to ensure effective medication management. Complexities include balancing patients’ preferences with ‘best practice’ guidance and system logistics related to (de)prescribing and coordinating decisions related to medicines use across different contexts including out-of-hours care.

Conclusion System design needs to facilitate collaborative working. We will demonstrate how our model will guide ethnographic work (phase two) to expand the model with what happens in practice, identifying the impact of process disturbances on quality and safety in work-as-done.

Impact Specialist Palliative Care lacks capacity to provide everyone who might benefit with direct care. Our research will create supportive resources for professionals, patients and families as well as a framework to identify promising areas for improvement.

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