To ensure that PRN injectable medications for end of life care are prescribed safely, in a timely and appropriate manner and that the drugs are received and given in the community as required. Our intention was to ensure patient comfort and safety at the end of life; whilst providing assessment and reassurance for community teams and GPs that end of life medications are being prescribed appropriately.Methods
A retrospective snapshot audit examining 37 community deaths known to St Raphael’s Hospice, between December 2015 and January 2016. Notes were accessed, results collated and analysed from online records held within the hospice.Results
Out of the 37 deaths recorded, 33 had injectable PRN medications requested. 35% of patients received medications within 24 hours of the request and 88% received them in less than two weeks. 78% of patients died within a month of PRN medications being prescribed. All patients had the correct opioids prescribed, with 43% receiving alternatives due to poor renal function. Once prescribed and received, 71% of patients used their medications within 24 hours of receiving them.Conclusions
The audit identified that the majority of patients are having their anticipatory medication prescribed appropriately prior to their death and were receiving them in a timely manner (within two weeks). However: considering that in most cases, medications were used within 24 hours, there is potential room for improvement. The process by which patients receive their PRN medication requires further investigation to identify and overcome possible problems. The audit also highlighted a number of cases of incomplete or inconsistent record keeping. This emphasised the importance of clear documentation, especially in the community, where multiple teams are involved in patients’ care.