58 Anticipatory prescribing for continuous sub-cutaneous infusion: friend or foe?

Benson, Sinead; Cadwallader, Claire; Cartwright-Terry, Teena; Cooper, Malcolm; Monnery, Daniel; Finnegan, Clare; Giles, R.; Sadiq, Rehana; Watson, Amanda

doi:10.1136/spcare-2021-pcc.76

Cited by 2 publications

(6 citation statements)

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“… 39 Doctors and nurses report adverse patient events have occurred when medications were administered without an adequate clinical assessment of need or the wrong medication was given. 37 40 49 Views on the safety of prescribing anticipatory syringe pumps/drivers are divided: some consider them vital in ensuring timely symptom control, 5 37 while others view it as unsafe practice that can lead to inappropriate medications and doses being initiated. 37 …”

Section: Resultsmentioning

confidence: 99%

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Anticipatory prescribing in community end-of-life care: systematic review and narrative synthesis of the evidence since 2017

Bowers

Antunes

Etkind

et al. 2023

BMJ Support Palliat Care

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BackgroundThe anticipatory prescribing of injectable medications is recommended practice in controlling distressing symptoms in the last days of life. A 2017 systematic review found practice and guidance was based on inadequate evidence. Since then, there has been considerable additional research, warranting a new review.AimTo review the evidence published since 2017 concerning anticipatory prescribing of injectable medications for adults at the end-of-life in the community, to inform practice and guidance.DesignSystematic review and narrative synthesis.MethodsNine literature databases were searched from May 2017 to March 2022, alongside reference, citation and journal hand-searches. Gough’s Weight of Evidence framework was used to appraise included studies.ResultsTwenty-eight papers were included in the synthesis. Evidence published since 2017 shows that standardised prescribing of four medications for anticipated symptoms is commonplace in the UK; evidence of practices in other countries is limited. There is limited data on how often medications are administered in the community. Prescriptions are ‘accepted’ by family caregivers despite inadequate explanations and they generally appreciate having access to medications. Robust evidence of the clinical and cost-effectiveness of anticipatory prescribing remains absent.ConclusionThe evidence underpinning anticipatory prescribing practice and policy remains based primarily on healthcare professionals’ perceptions that the intervention is reassuring, provides effective, timely symptom relief in the community and prevents crisis hospital admissions. There is still inadequate evidence regarding optimal medications and dose ranges, and the effectiveness of these prescriptions. Patient and family caregiver experiences of anticipatory prescriptions warrant urgent investigation.PROSPERO registrationCRD42016052108

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Section: Resultsmentioning

confidence: 99%

“… 37 40 49 Views on the safety of prescribing anticipatory syringe pumps/drivers are divided: some consider them vital in ensuring timely symptom control, 5 37 while others view it as unsafe practice that can lead to inappropriate medications and doses being initiated. 37 …”

Section: Resultsmentioning

confidence: 99%

Anticipatory prescribing in community end-of-life care: systematic review and narrative synthesis of the evidence since 2017

Bowers

Antunes

Etkind

et al. 2023

BMJ Support Palliat Care

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“…24,25 Careful and timely individualised prescribing is required to minimise potential risks to patient safety. 7,10,24–26…”

Section: Discussionmentioning

confidence: 99%

“…Some clinicians see them as vital in ensuring timely symptom control 10,24 while others view it as unsafe practice that may lead to medications and doses being initiated without a suitably skilled clinical assessment. 24,25 Careful and timely individualised prescribing is required to minimise potential risks to patient safety. 7,10,[24][25][26] Haloperidol, Cyclizine and Glycopyrronium were particularly underused and accounted for nearly two-thirds of the total wastage cost (Table 1).…”

Section: Main Findings Of the Studymentioning

confidence: 99%

“…24,25 Careful and timely individualised prescribing is required to minimise potential risks to patient safety. 7,10,[24][25][26] Haloperidol, Cyclizine and Glycopyrronium were particularly underused and accounted for nearly two-thirds of the total wastage cost (Table 1). Guidance recommends prescribing based on likely symptoms; 2,27 more research is needed to understand prevalent last-days-of-life symptom profiles and which medications are likely to be needed for various patient groups.…”

Section: Main Findings Of the Studymentioning

confidence: 99%

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The financial costs of anticipatory prescribing: A retrospective observational study of prescribed, administered and wasted medications using community clinical records

Morgan,

Barclay,

Pollock

et al. 2023

Palliat Med

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Background: The prescribing of injectable end-of-life anticipatory medications ahead of possible need is recommended best practice. The financial costs of these medications have been little studied. Aim: To identify the costs of anticipatory medications prescribed, used and not used for patients approaching the end-of-life at home and in residential care. Design: Retrospective observational study using general practitioner and community nursing clinical records. Setting/participants: Data were collected from eleven general practitioner practices using the records of the 30 most recent deaths per practice. Patients were aged 18+ and died between 2017 and 2019 from any cause except trauma, sudden death or suicide. Results: Anticipatory medications were prescribed to 167/329 patients, of which 164 were included in the analysis. Costs (GBP) were analysed both at patient-level and drug-level. Median anticipatory prescription cost was £43.17 (IQR: £38.98–£60.47, range £8.76–£229.82). Median administered (used) drug cost was £2.16 (IQR: £0.00–£12.09, range £0.00–£83.14). Median unused (wasted) drug cost was £41.47 (IQR: £29.15–£54.33, range £0.00–£195.36). Prescription, administered and unused costs were significantly higher for the 59 patients prescribed an anticipatory syringe driver. There were wide variations in the unused costs of individual drugs; Haloperidol and Cyclizine contributed 49% of total unused costs. Conclusion: The costs of prescribed and unused anticipatory medications were higher than previously reported but remain modest. Usage of prescriptions was lower than previously documented. There may be scope to reduce the quantity of vials that are routinely prescribed without adversely affecting care; further research is needed to investigate this possibility.

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58 Anticipatory prescribing for continuous sub-cutaneous infusion: friend or foe?

Cited by 2 publications

References 0 publications

Anticipatory prescribing in community end-of-life care: systematic review and narrative synthesis of the evidence since 2017

Anticipatory prescribing in community end-of-life care: systematic review and narrative synthesis of the evidence since 2017

The financial costs of anticipatory prescribing: A retrospective observational study of prescribed, administered and wasted medications using community clinical records

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