The aim of this project is to empower patients and families to take an active role in symptom control at end of life. A multiprofessional team has been working together to develop a policy which will enable informal carers to administer as required subcutaneous medication at end of life. This project has been informed and guided by patients and carers. The rationale for this project is to:

• Enhance symptom control by more rapid administration of as required injectable medication, potentially enabling patients to remain at home

• To support and empower family members who want to provide this type of support to the patient, ensuring underpinning training and education is in place

• To complement rather than replace existing services, district nursing support will continue to be required

• To have a positive impact upon bereavement, enabling families to feel that they have done all that they can do for their loved one.

We have faced multiple challenges in developing this policy not least professional concerns relating to prescribing medication which will be administered by an informal carer and the professional implications of supporting informal carers to administer the prescribed medication. Initially it was hoped that this project would include the acute sector but this has been too difficult to achieve. Careful multiprofessional working has been critical.

We now have support to proceed from Worcestershire Clinical Commissioning Group, St Richard’s Hospice and a General Practitioner (GP) locality team. An outline paper, inclusion/exclusion criteria and process has been agreed. Supporting documentation and underpinning training is being developed. We aim to pilot the policy commencing August 2018. Our approach will be on a patient by patient basis. Patients will be highlighted to the GP by St Richard’s Hospice Clinical Nurse Specialists. There will be ongoing review of this policy’s use.