Developing a policy to empower informal carers to administer subcutaneous medication in community palliative care; a feasibility project

Abstract

From the small numbers audited it could be suggested that if the process is well managed and the informal carers feel supported they can safely and effectively administer subcutaneous injections in community palliative care. More importantly, if a policy is available, staff can respond to requests from carers in a timely manner.

Managing Medicines for Patients Dying at Home: A Review of Family Caregivers' Experiences

“…This was often via an already placed access line and using predrawn medications (although this was not clear in all the articles). However, greater involvement of FCGs in the administration of syringe drivers and other procedures is clearly the direction of travel in the U.K., and some small-scale trials have already taken place 52,53 or are underway 54 to assess the feasibility of this approach in the U.K. In some areas, FCGs can be assessed and trained to undertake this task, although it is difficult to know the scale of this practice across the U.K. 55,56 Taking on the administration of medications for a family member is a considerable responsibility, and Kazanowski 44 reported that many FCGs took on the role by default rather than choice, which raises the question of whether FCGs may feel that this responsibility is imposed on them.…”

“…In the U.K., very few FCGs are trained to give anticipatory medications at the end of life, and one of the key stipulations of the National Health Service policies that do allow FCGs to take on this extended role is one of choice. 53 Indeed as Saltmarsh 57 comments, it must be ensured that relatives do not feel coerced either by a loved one's wish to die at home or by under-resourced community services. Thus, in providing the best possible care for dying patients, 58 we should not lose sight of the interests and entitlement of relatives and patients.…”

“…Indeed in the U.K., access to 24 hours of telephone support from specialist palliative care would be a fundamental component in endorsing an FCG to be trained to administer subcutaneous injections in the home at the end of life. 53,55,56 What is less clear is what support is in place for FCGs providing ongoing management and administration of medications that are not part of Core 4 anticipatory medications. 62 All the issues raised by FCGs in the reviewed articles echo those expressed by registered nurses who took part in a study to explore their roles in anticipatory prescribing in the U.K. 24 Nurses reported finding the administration phase of the process particularly ethically challenging.…”

Hjemmedød: Dette får sykepleiere til å bruke medikamentskrinet

“…Paradoksalt nok viser internasjonale studier at medikamentskrinet i stor grad også blir administrert av pårørende for å lindre pasienter i livets siste fase (10,11). De vil, som ufaglaerte, bestemme hvilken medisinering døende har behov for.…”

“…Det legges i dag stor vekt på å skape e ektive og samfunnsøkonomiske tjenester. Medikamentskrinet kan bidra til god lindrende behandling også på kveldstid og i helger, og kan i noen sammenhenger også administreres av pasientens pårørende (3,11). Hensikten med vår studie (7) var å utvikle ny kunnskap om hjemmesykepleieres erfaringer med å bruke medikamentskrinet i symptomlindrende omsorg for hjemmeboende pasienter i terminalfase.…”