PT - JOURNAL ARTICLE AU - Séamus Coyle AU - Rebecca Sinden AU - Jade Wignall-Coyle AU - Sinead Benson AU - Paula Powell AU - Daniel Monnery TI - Continuous subcutaneous infusion: is community anticipatory prescribing and administration safe? AID - 10.1136/bmjspcare-2021-003259 DP - 2021 Nov 23 TA - BMJ Supportive & Palliative Care PG - bmjspcare-2021-003259 4099 - http://spcare.bmj.com/content/early/2021/11/23/bmjspcare-2021-003259.short 4100 - http://spcare.bmj.com/content/early/2021/11/23/bmjspcare-2021-003259.full AB - Objective The anticipatory prescribing of pro re nata medications and continuous subcutaneous infusion (CSCI) medication is essential for the timely management of symptomatic patients at the end of life. There is no evidence to support the safety or appropriateness of anticipatory CSCIs. In 2013, in response to safety concerns about end of life prescribing in the community, we designed an educational intervention to improve prescribing practices among non-specialist prescribers in this area.Methods: how the study was performed We performed a safety-focussed retrospective cohort analysis of end of life community prescriptions of anticipatory CSCIs over a 12-month period, 5 years after creating clinical guidelines and embedding a multiprofessional rolling education programme. Medications prescribed and administered for symptom control at the end of life are compared between specialist and non-specialist prescribers in terms of their adherence to best practice guidance.Results Medications prescribed were not universally administered and more commonly not administered without specialist input. Prescriptions of higher doses of opioids and benzodiazepines beyond those recommended by guidance were significantly greater within the cohort of patients receiving specialist oversight. The prescription of a dose range did not result in excessive dose escalation. For patients not receiving specialist palliative care, median morphine and midazolam doses did not escalate at all once a CSCI was commenced. All midazolam administrations were safe.Conclusions The practice of anticipatory CSCI prescribing and administration can be safe in the community non-specialist setting when supported by clinical guidelines, specialist advice and ongoing multiprofessional education.Data are available upon reasonable request. All participant data are deidentified.