Introduction NICE quality standards (2011) state palliative care drugs should be fully accessible 24/7. National drug shortages, insufficient local stockholdings and prescriptions for items not on the recommended palliative list can make this problematic especially out of hours (OOH). There is little research on referral patterns for accessing subcutaneous medicines OOH.

Objectives

1. Determine if subcutaneous palliative medicines are fully available OOH Investigate whether supplies vary between hospital and community pharmaciesUnderstand referral patterns to access medication

Method A 12 month retrospective audit of GP OOH supplies from a hospital pharmacy with a prospective 4 week audit and carer survey in a large community pharmacy providing OOH supplies.

Results Locally derived standards from commissioned service set at 100% (n = 68 in GP OOH/hospital, n = 21 in community pharmacy).

100% of core subcutaneous medicines were available 24/7. Use of midazolam, diamorphine and hyoscine butylbromide similar across both settings; however levomepromazine was more common in the community following a national shortage of haloperidol. See table 1.

29% of community pharmacy issues were for formulations not on the recommended palliative list.

80% (4/5) patient referrals were made to the community pharmacy; 20% (1/5) going to more than one pharmacy.

Conclusion Subcutaneous palliative care drugs are fully available in the OOH setting however further research should be undertaken to assess referral patterns.

Reference

1. National Institute for Health and Care Excellence (NICE). Quality Standard 13 End of life care for adults. London: NICE; 2011