Background Anticipatory Medicines (AM) are injectable medicines prescribed and administered to patients to alleviate symptoms at the End of Life (EOL). Whilst prescribing of these medicines is encouraged by the healthcare system in Leicester, Leicestershire and Rutland, the actual patterns of prescribing and administration of AM have not been documented locally.
Aim To describe the prescribing and usage of AM in the community, matching this to EOL symptoms experienced by patients.
Method A retrospective audit of 150 sets of patient notes was conducted at the start of 2017, comprising 50 deaths from one General Practice list, 50 deaths from Community Palliative Care Nursing teams, and 50 hospice discharges. Data included the main diagnosis at death; and details of prescription and usage per ampule of each AM.
Results General Practice data analysed thus far indicates:
• Death by primary diagnosis: Cancer 16/50 (32%), Chronic Disease 5/50 (10%), Frailty/Dementia 22/50 (44%), Sudden Death 5/50 (10%)
• AM issued by diagnosis: Cancer 10/16 (62%), Chronic Disease 0/5 (0%), Frailty/Dementia 11/22 (50%), Sudden Death 1/5 (20%)
• Median number of days AM issued and started [X] before death: Cancer 14, Chronic Disease (N/A), Frailty/Dementia 6, Sudden Death 11.
• Number of patients documented having EOL symptoms (13): Cancer 4, Chronic Disease (N/A), Frailty/Dementia 8, Sudden Death 1
• EOL symptoms experienced: Pain: 12 (Cancer 3, Frailty/Dementia 8, Sudden Death 1), Breathlessness: 3 (Frailty/Dementia 3), Agitation 2 (Cancer 1, Frailty/Dementia 1), Nausea 1 (Cancer 1), Vomiting 2 (Frailty/Dementia 2).
• Syringe Driver use: Cancer (2), Frailty/Dementia (5), Sudden Death(1)
• Total AM ampule usage [Number patients]: 0 [10 Cancer (3), Frailty/Dementia(7)], 0–9 [8, Cancer (2), Frailty/Dementia(6)], 10–19 [2, Cancer (1), Sudden Death (1)], 20–49, [2, Frailty/Dementia (2)],≥50 [1, Cancer (1)]
Conclusions Patients with frailty/dementia have EOL symptoms similar to cancer, but with greater numbers in the community. AM prescription occurs a few days before their use. The data regarding Chronic Disease deaths in the community is limited in this audit. Further work is needed to analyse all datasets.
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