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46 An integrated pathway to access medicines for the palliative care patient in crisis in the out-of-hours period
  1. Gemma Donovan1,2,
  2. Stephen Foster3,
  3. Marc Herscovitz4,
  4. Andrew Griffiths4 and
  5. Denise Slark5
  1. 1NHS Sunderland CCG, UK
  2. 2University of Sunderland, UK
  3. 3Sunderland On-Call Pharmacy Service, UK
  4. 4Vocare, UK
  5. 5St Benedict’s Hospice, South Tyneside NHS Foundation Trust, UK


Introduction It is recognised that community rapid response services can face difficulties in sourcing medicines to support end-of-life care (Butler and Holdsworth, 2013). Medicines used in the out-of-hours (OOH) period cannot usually be dispensed directly to the patient due to community pharmacies being closed. This can prevent the setup of syringe drivers and/or administration of prescribed stat doses. Here, an on-call pharmacy service was commissioned but not well integrated into pathways of care.

Aim To optimise the treatment of palliative care patients in crisis, using an integrated pathway.

Method A Rapid Process Improvement Workshop (RPIW) was used to map the process of managing a patient in crisis, and plan a more efficient pathway to access medicines across nursing, medical and pharmacy services.

Results An integrated pathway was developed to facilitate best use of healthcare professional time to deliver palliative care (see below). An on-call pharmacy service is key to its delivery. In 2015/16, palliative care nurses were coordinating medicines supply for 95% pharmacy call-outs (n=38), since implementation of the new pathway in 2016/17 this has reduced to 42% (n=31). At baseline, it was estimated that sourcing medicines by nurses took four to five hours, the new service takes an average 49 min from call-out to patient delivery of required medicines.

Conclusion Commissioning an on-call pharmacy service using an integrated pathway for patients in crisis enables efficient supply of medicines during the OOH period, optimising use of nursing, pharmacist and medical time to facilitate timely access to medicines for symptom management.


  1. . Butler, C. and Holdsworth, L. (2013) ‘Setting up a new evidence-based hospice-at-home service in England’, International Journal of Palliative Nursing, 19(7), pp. 355–359

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