PT  - JOURNAL ARTICLE
AU  - Lee, Charlotte
AU  - Tran, Theresa Tammy
AU  - Ross, Joy
TI  - Anticipatory prescribing in community end-of-life care
AID  - 10.1136/spcare-2023-004270
DP  - 2024 Sep 01
TA  - BMJ Supportive & Palliative Care
PG  - 353--357
VI  - 14
IP  - 3
4099  - http://spcare.bmj.com/content/14/3/353.short
4100  - http://spcare.bmj.com/content/14/3/353.full
SO  - BMJ Support Palliat Care2024 Sep 01; 14
AB  - Objectives Our work aims to critically review the use of anticipatory medicines in our inner-city hospice community population and whether our current practices are fit for purpose.Methods Retrospective audit of community palliative care patients at the end-of-life prescribed anticipatory medicines within a 3-month period. Anticipatory charts and case notes reviewed. Intervention included updating local guidelines, local teaching for medical and non-medical prescribers and sharing results nationally. Eighteen months later, reaudit was performed assessing impact.Results In total, 76 patients included. 75/76 (99%) were prescribed an analgesic, antiemetic, antisecretory and anxiolytic. 49/76 (64%) were administered ‘as required’ medications at home. Haloperidol was the favoured antiemetic (88%), costing our hospice ~£2000/month. Case note review highlighted prescribing and administration issues. Reaudit showed a reduction in prescriptions of antisecretory (by 57%) and antiemetic (by 50%), with a wider range of antiemetics (levomepromazine 47%, haloperidol 35%, cyclizine 14%, metoclopramide 3%) indicating individualised prescribing. Those without an antiemetic prescribed did not later require one dispensing.Conclusion Our work challenges the orthodoxy that an analgesic, antiemetic, antisecretory and anxiolytic medication must always be included for effective anticipatory prescribing. Antiemetics may not be universally required and individualised prescribing was cost-effective and safe at a local level. Further work evaluating the impacts of altered practice on patients, caregivers, professionals and in other community settings is required.Data are available upon reasonable request. Raw clinical data are held securely by St. Christopher’s Hospice. Please contact senior author for further information.