Background The fourth round of the National Audit of Care at the End of Life (NACEL) reported that across The Dudley Group NHS Foundation Trust (DGFT) the use of prescribed anticipatory medications was lower than the national average (40.5% vs. 69.1%). This review aimed to understand if this reduction was suggestive of adverse patient care outcomes or any barriers to their utilisation and if not provide assurance.

Method Over three days, all patients prescribed anticipatory medications or identified as dying on each ward were reviewed twice daily by authors. Using a proforma, authors recorded patient factors and anticipatory use before discussing with the patient’s responsible nurse any symptoms they have identified and actions they had taken. This was followed by a visual review of the patient to confirm the reported handover. Clarification was sought from the DGFT Research team to confirm ethical approval was not required.

Results 118 contacts were performed on 27 patients; 33% with cancer and 66% with non-cancer diagnosis. All patients were recognised as either GSF Red or Amber. Reviews were conducted on a mixture of surgical, medical and acute ward areas. In 47% of patient contacts staff had identified a symptom and reported an action for that symptom in 100% of cases. The reported actions included utilising the prescribed anticipatory medication, utilisation of non-pharmacological management or alternative medication (such as oral medication if able to swallow). There was high consensus (99%) with the authors ward review.

Conclusion Ward teams across DGFT utilised a breadth of management options to support their patients symptoms at the end of life beyond relying solely on anticipatory medications. Reassuringly there was no evidence that this holistic approach had been detrimental in achieving the desired control of symptoms. There was assurance that teams are empowered to utilise non-pharmacological techniques to support alongside anticipatory medications if needed.