Background The CQC recommends palliative care units benchmark their controlled drug prescribing against similar units. We gathered prescribing data across Wessex to enable units to meet this aim, as well as comparing prescribing of other common end of life drugs.
Methods We collected data on the first ten deaths to occur in January 2021 from specialist palliative care units (SPCUs) and hospital palliative care teams (HPCTs) across Wiltshire, Dorset and Hampshire. Data was collected from two time points (24 hours and 5 days before death) concerning the prescribing of opioids, benzodiazepines, adjuvant analgesics and other anxiolytics.
Results 21 units participated: 8 HPCTs and 12 SPCUs. Data for 210 patients 24 hours before death and 144 patients 5 days before death. 73% of patients on regular opioid 24 hours before death (39% under HPCT, 88% SPCU, 82% community), oral morphine equivalent dose range 10–800 mg, mean dose 88 mg (69 mg HPCT, 99 mg SPCU). 59% on regular benzodiazepine 24 hours before death (35% under HPCT, 76% SPCU, 55% community), midazolam equivalent dose range 5–70 mg, mean dose 17.8 mg (15.2 mg HPCT, 18.3 mg SPCU). 34% of patients received Levomepromazine in the 24 hours before death (20% under HPCT, 43% SPCU) and 6% Haloperidol. 19% of patients received adjuvant analgesics 24 hours before death, compared to 27% five days before.
Conclusion This project enabled the participating units to meet the CQC recommendation. It highlighted wide variation amongst prescribing at the end of life; possible explanations for this include differences between specialist and generalist settings in terms of staff experience and patient cohort. We acknowledge the limitations of our small sample size and the possible influence of COVID-19. It may be helpful in future to repeat with larger numbers in order to draw more generalisable conclusions about end of life prescribing.
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