Development of an End-of-Life Core Medicines List for Community Patients

Abstract

BackgroundTimely access to medicines within the community is important for palliative patients where their preferred place of care is the home environment. This is particularly relevant in the terminal phase of a palliative illness. Commonly encountered symptoms in the terminal phase include: pain, dyspnoea, restlessness, noisy breathing and nausea. While existing national guidelines influence the management of symptoms for palliative patients, the range of medicines usually needed within the community setting to treat noncomplex terminal phase symptoms is less than required in a tertiary inpatient palliative care unit.AimTo (1) Analyse a variety of palliative resources to identify the pharmacological management of common symptoms in the terminal phase; and (2) Create an end-of-life Core Medicines List that guides consistent prescribing for noncomplex community palliative patients in the terminal phase.MethodsSeven stakeholders representing all consultant-led palliative services in South Australia discussed the management of five common symptoms observed in the terminal phase of a palliative illness. The selection of the core medicines took into consideration cost, availability in the doctor's bag, access to government subsidies (eg, PBS) and drug properties.ResultsThe five end-of-life core medicines selected for noncomplex community patients are:Clonazepam 1 mg injection;Haloperidol 5 mg/ml injection;Hyoscine butylbromide 20 mg/ml injection;Metoclopramide 10 mg/2 ml injection; andMorphine 10 mg/ml injectionDiscussionThere is some overlap in the symptoms which these medicines control, thus allowing some options despite the restricted list.ConclusionA concise end-of-life core medicines list of five medicines has been developed to guide prescribing by community clinicians.

A qualitative exploration of the role of a palliative care pharmacist providing home‐based care in the rural setting, from the perspective of health care professionals

“…11,12 They are also able to educate and support other health care professionals in the palliative care team. 13 However, pharmacists are not typically recognised as a core part of palliative care teams, particularly in the context of home-based care. 11,[14][15][16] Moreover, a recent position paper from the UK identified that patients and caregivers were unaware of the potential for pharmacists to help with medication management at home.…”

“…Pharmacists' areas of speciality include medication reviews, symptom management, monitoring and reporting of adverse drug reactions and interactions, counselling and education for patients and caregivers 11,12 . They are also able to educate and support other health care professionals in the palliative care team 13 . However, pharmacists are not typically recognised as a core part of palliative care teams, particularly in the context of home‐based care 11,14–16 .…”