Background The standard of practice for end of life care in the UK is to use anticipatory medications for symptom control. Given this it is important for the benefits or side effects of the medication to be identified so they can be adjusted to meet the patient‘s needs.
Aim To assess how frequently the response to anticipatory medications was documented by nursing staff, in both general wards and specialist palliative care beds at a district general hospital.
Methods A retrospective audit was conducted at a district general hospital in the UK. All palliative care referrals during October 2016 were audited for evidence of anticipatory medication use and whether there was any nursing documentation of its effectiveness. This was also done for all patients admitted to the newly-established specialist palliative care beds at the same hospital over a three month period in 2017.
Results 102 patients were referred to palliative care in October 2016, of which 50 had anticipatory medications given. Of 103 anticipatory medications administered 18.4% (19 out of 103 medications) had documentation of the effect on symptoms. There were 24 patients admitted to the specialist palliative care beds for end of life care over a 6 week perios, of which 21 had anticipatory medications administered. Of these patients 31.6% (18 out of 57 medications) had documentation of the effect on the patient‘s symptoms.
Conclusions This study demonstrates that the effect of anticipatory medications is poorly recorded in the nursing notes on wards in a district general hospital. However, there is improvement when the patient is managed in a specialist palliative care bed on a general hospital ward. Further training is required to improve this documentation and allow accurate monitoring of symptoms. The designated specialist palliative care bed model may provide an opportunity for training of nurses across the hospital.
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