IMPROVING ANTICIPATORY PRESCRIBING PRACTICES FOR ALL OLDER PATIENTS WITH AN ANTICIPATED DEATH IN HOSPITAL

Abstract Ref: 
0151

Jonathan Baillie, Samantha Sii, Hannah McGurk, Mark Roberts
Belfast Health and Social Care Trust, Belfast, United Kingdom

Background: The NICE guidelines advocate that adults in the last days of life who are
likely to need symptom control are prescribed anticipatory medicines with individualized
indications for use, dosage and route of administration (1). This study investigated the
extent older patients within an acute teaching hospital had anticipatory medicines prescribed
prior to death, as recommended by the Regional Palliative Medicine Group for
Northern Ireland (2).
(1) Care of dying adults in the last days of life (2015) NICE guideline NG31, recommendation
1.6.1
(2) http://www.professionalpalliativehub.com/guidelines/northern-ireland-pal...
tools-guidance

Methods: The study retrospectively reviewed the notes and kardexes of hospital inpatients
who had an anticipated death in hospital, and using an audit tool, established if
patients had been prescribed appropriate anticipatory medication for end of life care as
recommended by the Northern Ireland Regional Palliative Medicine Group. This included
medicines for 1. Pain,
2. Breathlessness,
3. Nausea and vomiting,
4. Anxiety, delirium and agitation
5. Chest secretions

Results: 55% of patients were prescribed all the medicines recommended to palliate
anticipated symptoms encountered during end of life care. All the patients had access to
opioids to palliate for pain and breathlessness. 95% of the patients had access to medication
to alleviate anxiety, delirium and agitation. 73% had access to medicines for chest
secretions and 59% had access to an anti-emetic.

Conclusion: From this baseline data, it is clear not all patients had access to the recommended
anticipatory medicines. We are now progressing to compare the effect of gradually
implemented interventions on improving anticipatory prescribing for patients at the
end of life. Example of interventions include prompting senior medical staff to ensure
medications have been prescribed, palliative care education for junior medical staff and
implementing a symptom observation chart. Our goal is to improve our prescribing of
anticipatory medicines and thus improve care for older adults in the last days of life.