Background In keeping with the ‘Care of dying adults in the last days of life’ NICE guidelines, inpatients are consistently prescribed anticipatory medications. However, decisions for inpatients discharged home were unclear. Evaluating clinical practice focusing on anticipatory prescribing, subsequently including other discharge decisions, was done to support multiple implementations to improve care.
Methods A retrospective baseline service evaluation of 16 patients discharged from the Inpatient Centre was performed. A new Standard Operating Procedure (SOP) was designed, liaising with the multidisciplinary team. Patients’ Phase of Illness guided decisions regarding anticipatory medication and community prescription charts on discharge. Changes to documentation were implemented, including medical discharge letters, Advance Care Planning documents and ward round decision aids. Links with GP out of hours (OOH) services were established. New standards were re-audited a year later, including 17 patients.
Results 44% vs 41% patients were discharged with anticipatory medication. However, it was unclear for the remaining 56% in the first cycle if anticipatory medication had been considered as there was no documentation. Following implementation, documentation in both the medical notes and medical discharge letters improved (44% and 71% vs 88% and 100% respectively). 83% vs 100% of those discharged with anticipatory medication received all four core medications. Community administration prescriptions increased from 14% to 100%. All patients’ medical discharge letters are now sent to GP OOH (previously 0%). The new electronic ACP proforma is being used as are Yorkshire Ambulance Service system alerts to help keep people at home.
Conclusions The SOP has been imbedded in clinical practice and provides much needed guidance for consistent decision-making regarding discharge, of which anticipatory medications is a component. Documentation has significantly improved, but the most significant change has been communication between specialist palliative care and primary care health providers including out of hours services to improve patient care.
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