P-64 Quality improvement project- end of life medication use

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Abstract

Background

Palliative care is a multidisciplinary approach to specialised medical care for patients with terminal illnesses, mainly providing relief from symptoms, physical and mental stress of an illness. There are multiple components to managing patients in terminal phase. Anticipatory prescribing of as required medication in advance is one of them. The significance lies in ensuring no delay in responding to a symptom. This retrospective audit was conducted to assess compliance with local guidelines.

Methods

Medical records of inpatient Deaths during November and December 2014 were requested and data specifically, medications prescription, was collected. There should be 4 prescriptions with clearly stated route, frequency, indication and maximum dose.

Results

Out of 56 patients included in the audit, only 25 patients received end of life care. 24 patients were included as 1 chart was unavailable. Only 74% patients had their regular medication discontinued. The most common choice of documentation was palliation (34%) followed by ‘keep comfortable’ (29%), with minority using phrases like ‘T.L.C’, ‘stop all treatment’. The audit revealed relatively satisfactory targets for respective prescriptions with the highest 87% for pain followed by 85% for nausea, 78% for agitation and dyspnea and lastly, 74% for respiratory secretion. Only a small number of Syringe driver was used - mainly pain relief with only 17%. Opioid Conversion is rather poor. Only 57% of the patients previously on regular pain relief had accurate dosing following the conversion chart.

Conclusion

To ensure anticipatory medication being accurately prescribed, end of life prescription chart would be introduced with opioid conversion chart included. Healthcare professionals should be given teaching and made aware of the chart and hospice service. Palliative care team should review all patients as soon as they are commenced on palliative care however this would not feasible as patients in hospital setting tend to die within days.

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