Background It is common informal practice in Australia for carers to be trained to administer PRN subcutaneous medications, especially in the last few days of life. A safe, legal and ethical framework for practice was needed to support end of life decision-making.

Aim To develop a culture of safety in the palliative care home setting by applying a Health Promoting Palliative Care philosophy, Kellehear (1999), to enable choice in place of care and death.

Method Team brainstorming and literature review – developed:

• Carer education programme to evaluate a carer’s preparedness to administer subcutaneous medications.

• Guideline

• Evaluation and Communication strategy

• Support Focus

• Ease of access to equipment

• Piloted 2009

Results Pilot 93% participants achieved wish to die at home – consistent at approximately 90% medication errors reduced. Carer confidence increased to confident and most confident. Hospital admissions reduced – remains approximately 8–10% of all days on service spent in hospital. Staff safety and satisfaction increased with reduction in after-hours home visits – averages remain at one or two per year. After-hours phone calls did not increase in response to practice changes.

Conclusion Health promotion, enablement and promotion of autonomy and support rather than control and disablement are powerful determinants of carer’s ability to cope when caring for the dying, and enduring bereavement. This project is now standard practice and has transformed community practice of palliative care empowering consumers and health professionals with such potential. However, in response to criticism of this practice the carer’s perspective will be captured in a carer survey.