Anticipatory prescribing at the end of life in Lothian care homes

Abstract

Common symptoms at the end of life include pain, breathlessness, anxiety, respiratory secretions and nausea. National end-of-life care strategies advocate anticipatory prescribing for timely management of these symptoms to enhance patient care by preventing unnecessary distress. This study investigated the extent to which residents in eight Lothian care homes had anticipatory medications prescribed prior to death. Data were collected as part of a service development project to improve palliative care in nursing care homes in Edinburgh. Of the 77 residents who died in the care homes, 54% had anticipatory medicines prescribed. Only 15% had prescriptions for all four nationally recommended anticipatory medications. Many care home residents do not have the recommended anticipatory medications in place in the last days of life and thus may experience inadequate symptom control. Interventions that increase the availability of anticipatory medicines to manage common symptoms at the end of life for care home residents are required.

Anticipatory prescribing of injectable medications for adults at the end of life in the community: A systematic literature review and narrative synthesis

“…50 Three retrospective studies in UK nursing home settings reported anticipatory prescribing rates varying from 37%, 43 28%–62%, 47 to 13–100%. 38 Although the data are limited by inadequate definitions of anticipatory prescribing, 43,47 patients at home or in care homes appear less likely to be prescribed drugs than those in nursing homes. 38,42,43,47 Surveys of community healthcare professionals suggest that anticipatory prescribing is widespread in the United Kingdom.…”

“…Few studies investigated the frequency of anticipatory prescribing in the community: these were primarily limited to the United Kingdom, and patient samples do not accurately represent the general population. 38,40,42,43,47,50 Reported figures varied greatly across studies which may relate to differences in study design, context, and denominators used. 38,40,42,43,47,50 A study of 12 GP practices in one UK county reported that anticipatory prescribing occurred in 16% of all predictable deaths in the community (home or care home).…”

“…38,40,42,43,47,50 Reported figures varied greatly across studies which may relate to differences in study design, context, and denominators used. 38,40,42,43,47,50 A study of 12 GP practices in one UK county reported that anticipatory prescribing occurred in 16% of all predictable deaths in the community (home or care home). 42 By contrast, a retrospective case note review of 150 consecutive deaths managed by a specialist palliative care team indicated that 63% of the sample had anticipatory prescribing in place at the time of death.…”

“…38 Although the data are limited by inadequate definitions of anticipatory prescribing, 43,47 patients at home or in care homes appear less likely to be prescribed drugs than those in nursing homes. 38,42,43,47 Surveys of community healthcare professionals suggest that anticipatory prescribing is widespread in the United Kingdom. 13,20 There is wide variation in the timing of anticipatory prescribing prior to death, ranging from a few days 3,49 to several weeks.…”

The importance of interdisciplinary communication in the process of anticipatory prescribing

“…Moreover, that study GP (McClelland et al, 2008:96). In some care homes these relationships may be inadequate due to high staff turnover (Tilden et al, 2012, Finucane et al, 2014, or care home staff having limited knowledge of palliative care drugs and how to control symptoms (Watson et al, 2006). However, findings from the study reported here show that communication and trust between GPs and care home nurses was facilitated by a move to a single GP practice.…”