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132 Improving the prescribing in a general hospital of 'as required' anticipatory medications for end of life symptoms, following the introduction of an electronic prescribing 'order-set'
  1. Debra Swann,
  2. Louise Renton,
  3. Caroline Adams,
  4. Elizabeth Heitz and
  5. Devesh Patel
  1. Croydon University Hospital


Background Availability of anticipatory medications for common end of life (EOL) symptoms is a quality indicator measured in recent hospital care of the dying audits. Local results from the 2013 audit demonstrated poor uptake of anticipatory prescribing. In 2014, the Trust moved to electronic patient records and prescribing across the acute trust. Working in partnership with the informatics leads for pharmacy and medicine,the palliative care team utilised the capabilities of 'Cerner's' electronic patient prescribing system to develop an 'order-set' of 5 medications, commonly needed at the end of life. The system went live in May 2015 and an early induction session to the new junior doctors was delivered in August 2015.

Aims To evaluate prescribing of anticipatory 'as required' EOL medications, following the introduction of the palliative care 'order-set'.

Methods A retrospective review of anticipatory, 'as required', prescribing for a 1 month period was undertaken 12 months after introducing the prescribing 'order-set'. Criteria applied as for the 2013 National Hospital audit.

Results were compared with local results from 2013. Baseline information from 2013 showed that the Trust under-performed for prescribing for all symptoms: (Agitation- 23%, Breathlessness- 20%, Nausea- 14%, Pain- 27%, and Secretions- 7%).

Twelve months after implementation of the 'order- set' the results were: (Agitation- 68%, Breathlessness- 74%, Nausea- 68%, Pain- 74%, and Secretions- 65%). These results are all above the national average from the 2016 RCP: National End of life care audit.

Conclusions Introduction of an electronic palliative care prescribing 'order-set' for anticipatory EOL medications, has demonstrated considerable improvement in the uptake of anticipatory prescribing for dying patients. This in conjunction with an early palliative care induction education session for junior doctors has demonstrated significant improvements in the quality of prescribing in the end of life phase of life for patients in an acute hospital.

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