Background “Just in Case” anticipatory prescribing schemes are seen as one way of ensuring that patients nearing the end of their lives can have access to rapid relief of symptoms at home. The Gold Standards Framework for End of Life care encourages this a mainstay of care. No large scale attempts to examine the practice have been undertaken.
Aims To assess the implementation of “Just in Case” bags in Devon over the first two years of the scheme. Feedback was sought from health professionals over the key features of the initiative, the drugs used and any problems encountered. A subsidiary aim was to assess the cost effectiveness of the scheme.
Approach used 83 GP practices in Devon were issued with a stock of “Just in Case” bags. A record was kept of when each bag was dispensed. Each bag was issued with a service evaluation form inside. The completed forms were returned to a central collection point allowing the total number of bags dispensed, and then used, to be measured. Data was collected between April 2011 and the end of March 2013.
Outcomes 1510 bags were dispensed during the period and 295 service evaluation forms were returned (20% return rate). The bags were well received by staff, patients and relatives alike. The most common four drugs prescribed were Diamorphine, Hyoscine Hydrobromide, Midazolam and Levomepromazine.
Application to hospice practice An attempt was made to calculate the overall cost of the project and any savings from the scheme. The information gathered from the 295 completed evaluation forms suggested that 121 admissions to Hospital or Hospice were prevented. The bags also offered peace of mind for patients and relatives. The challenges of organising a large-scale service evaluation across multiple professional teams and of assessing projected financial savings are also discussed.