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P-116 Improving provision of timely anticipatory medications at end-of-life for community patients; where have we got to?
  1. Joy R Ross and
  2. Nigel Dodds
  1. St Christopher’s Hospice, London, UK


Background An ongoing challenge, both across our healthcare systems and for individual patients and families, remains regarding access to ‘just-in-case’ (JIC) medications to support symptom control at end-of-life (NICE. Guidance End of life care for adults. Quality standard [QS13]). Our community teams work across 5 CCGs, caring for approximately 1200 patients (own home or care home). Timing, assessment, procurement and administration of such medications, the governance and cost associated with this, particularly out-of-hours, needs further evaluation. Local community processes are not well established, with significant delays.

Aim This work builds on a previous service evaluation of JIC medications provided by the hospice to our community patients (Tran, Lee & Ross, 2021. BMJ Support Palliat Care. 11: A60).

Method Retrospective review of internal prescriptions for medications over 1 month including prescriber, medications given, with more detailed case-note review (of two-thirds) to identify themes/challenges and outcomes.

Results 159 prescriptions were written by doctors (45%) or NMPs over 1 month. 16% of patients required >1 prescription (range 2-7), with peak requests on a Friday. This cohort was elderly, half ≥85 years old; 49% had a primary cancer diagnosis (vs 51% non-malignant), a third also had a dementia diagnosis. Three months later, 85% had died (89% in their usual residence) median time to death 6 days. 20% of prescriptions were a new/urgent referral; 52% required urgent OOH visits. 94% included injectable medications (vs 3 transdermal analgesia; 3 PR paracetamol; 4 other). 73% received injectable opioids (Morphine 57%, Oxycodone 34%, Alfentanil 9%). We saw a 50% reduction in scripts for antiemetics, with reduction in haloperidol (79% to 35%) versus other antiemetics (levomepromazine 47%, cyclizine 14%, metoclopramide 3%) both of which were key outcomes to improve cost-effectiveness from our previous service evaluation. We documented administration of these injectable meds (stats or CSCI) in 55%. Themes/Challenges will also be presented.

Conclusion Projects to evaluate and change practice in this area can be effective; further integrated working to establish and evaluate cost-effective pathways to access medications at end-of-life is essential.

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