Article Text

Download PDFPDF

P-70 Anticipatory CSCI prescribing and administration in the community – is it safe?
  1. Séamus Coyle1,2,
  2. Rebecca Sinden2,
  3. Jade Wignall-Coyle3,
  4. Sinead Benson1,
  5. Paula Powell4 and
  6. Dan Monnery1
  1. 1The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
  2. 2University of Liverpool, Liverpool, UK
  3. 3Mersey Care NHS Foundation Trust, UK
  4. 4Willowbrook Hospice, Prescot, UK


Background The anticipatory prescribing of PRN medications and continuous subcutaneous infusion (CSCI) medication is essential for the timely management of symptomatic patients at the end of life. There is no evidence to support the safety or appropriateness of anticipatory CSCIs. In 2013, in response to safety concerns about end of life prescribing in the community, we designed an educational intervention to improve prescribing practices among non-specialist prescribers in this area.

Methods We performed a safety-focused retrospective cohort analysis of end of life community prescriptions of anticipatory continuous subcutaneous infusions over a 12 month period, 5 years after creating clinical guidelines and embedding a multi-professional rolling education programme. Medications prescribed and administered for symptom control at the end of life are compared between specialist and non-specialist prescribers in terms of their adherence to best practice guidance.

Results Medications prescribed were not universally administered and more commonly not administered without specialist input. Prescriptions of higher doses of opioids and benzodiazepines beyond those recommended by guidance were significantly greater within the cohort of patients receiving specialist oversight. The prescription of a dose range did not result in excessive dose escalation. For patients not receiving specialist palliative care, median morphine and midazolam doses did not escalate at all once a CSCI was commenced. All midazolam administrations were safe.

Conclusions The practice of anticipatory continuous subcutaneous infusion prescribing and administration can be safe in the community non-specialist setting when supported by clinical guidelines, specialist advice and ongoing multi-professional education.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.