Objective The objective of this review is to investigate the use of the subcutaneous route of administration of analgesics, common practice within palliative medicine. Design Systematic review using consensus approach, direct comparison of subcutaneous route with intravenous and intramuscular routes. Results The limited available evidence demonstrates non-inferiority of the subcutaneous route in both cancer patients and those post-surgery. Pain management is comparable to other routes. Route-related side effects are rare and systemic side effects are comparable. Conclusion Pain management is a critical role of palliative medicine. The subcutaneous route of administration offers a viable option for the delivery of parenteral analgesia within all settings, including the community. This review supports current practice, demonstrating equivalence with more invasive routes of administration.

BackgroundResearch shows that more than 30% of hospital inpatients over 85 may die within the next year. Advance Care Planning (ACP) has been shown to increase achievement of preferred place of death and decrease unnecessary hospital admissions in the last year of life. Accordingly, local Elderly Care discharge summaries include a mandatory ACP section. As part of the ‘Building on the Best’ quality improvement programme, our Trust is focusing on improving handover of ACP information as people move between healthcare settings.AimsTo determine best practice in sharing information on ACP between hospital and community servicesTo review current transfer of information about ACP on discharge from an Elderly Care ward.MethodWe reviewed relevant literature about transfer of information on discharge summaries and retrospectively audited 30 discharges from an elderly care ward. We recorded inclusion of key ACP topics, such as cardiopulmonary resuscitation status and preferred place of death, as well as deaths within the subsequent six months.ResultsLiterature review highlighted importance of high quality information in discharge summaries to decrease inappropriate readmission in last year of life. No discharge summaries audited included any information in the ‘mandatory’ ACP section50% documented DNAR status separately53% of patients were readmitted to our hospital within six months30% died within six months.ConclusionAlthough a significant proportion of patients on elderly care wards are in the last year of life, there was minimal sharing of ACP information with community services. The ‘process’ change of including a mandatory ACP section on discharge summaries has not improved outcomes. Future quality improvement will focus on staff engagement and raising awareness of the importance of ACP. We have developed a blended learning programme to support the implementation of routine identification of patient in their last year of life in multi-disciplinary meetings, thereby triggering ACP and communication across organisations.

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