Introduction/Background The potential benefit of using an anticipatory driver is more robust symptom management at the end of life, with less need for repeated injections, which may be particularly useful in the community setting. While national guidance on the issue lacks clarity, the Association of Supportive and Palliative Care Pharmacy (ASPCP) recently stated that the ‘perceived benefit of the anticipatory prescribing of a syringe pump does not outweigh potential risks’. Despite some negative publicity post-Gosport, such prescribing still appears relatively common. The use of a safe, appropriate anticipatory syringe pump relies on both an experienced prescriber, and an experienced caregiver to decide when to administer.
Methods A retrospective audit of all admissions to a hospice inpatient unit (IPU) between 1st July - 1st October 2021 was performed. All drug charts were checked for the presence of an anticipatory driver, appropriateness of doses, and documentation of any indication/instructions. Furthermore, clinical notes were analysed to establish the clinical context.
Results Across 73 patient admissions (over 3 months), 46 syringe drivers were prescribed, of which 21% were anticipatory. 10 (100%) of the anticipatory drivers were prescribed for patients who died on IPU, at appropriate starting doses, and an appropriate rationale was documented in 8/10 cases. Only 3 (30%) of all anticipatory drivers were administered, and the decision to administer was made by the nurse caring for the patient, predominantly out of hours.
Conclusion This is an area of practice that has both potential strong benefits and significant risks, and needs clear national guidance. In order to reduce risks, anticipatory drivers should be prescribed cautiously and only by experienced professionals, and documentation needs to be clear. While a hospice IPU may be a less risky setting for their use, specific training and support could be offered to community professionals to increase safe prescribing and administration.
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