Introduction Prescribing medications for patients ‘to take out’ (TTO) on discharge is a routine task for junior doctors. Prescribing end of life care medications as a TTO, such that a rapid discharge can be arranged for a patient wishing to die at home, is not so common.
Inspiration and aim Born out of a highly emotive incident in which a patient did not receive his medications, a project to test, and subsequently improve, the accuracy of TTO prescriptions of these medications was initiated.
Method A cohort of foundation year one doctors undertook an end of life care prescribing quiz (Quiz 1), asking them to give an example prescription for both controlled and non-controlled drugs, and to state any additional documentation required to validate the prescription in the community. A guideline was then created in collaboration with the palliative care team, junior doctors and pharmacists to improve the accuracy of TTO end of life care medications. The new guideline was delivered alongside a palliative care teaching session, with cross-reference to the Trust’s palliative care guidelines. The same cohort of doctors then re-took the prescribing quiz (Quiz 2).
Results The results of Quiz 1 highlighted worrying prescription inaccuracies: only 5% (1/20) of doctors correctly prescribed the medications and only 10% (2/20) identified the need for a community prescription chart. After guidance and training there was a considerable improvement in prescription accuracy (Quiz 2), with 75% (15/20) of doctors correctly prescribing the medications, and 88% (17/20) identifying the additional chart needed for administration.
Future Going forward, the guideline is to be distributed to all junior doctors within the trust, through inclusion on the intranet and the introductory handbook, such that future situations of delayed dispensing of end of life care medications can be avoided.
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