P_CS_18 Pre-emptive Prescribing and Supply of Palliative Care Medications

There are a number of end of life tools in use in practice within Lincolnshire to support the improvement of, and best practice in, end of life care. These include the Gold Standards Framework (GSF), Advance Care Planning (ACP) and the Liverpool Care Pathway (LCP). These frameworks help to develop and implement a standard of quality care, including pre-emptive prescribing for distressing symptoms.

Involving patients and their carers in decisions about their end of life care and improving access to high quality personalised care closer to home at end of life is a key focus within Lincolnshire. Although between 60 and 67% of people in England have stated that they would prefer to die at home (Cicely Saunders International 2011), approximately 42% of deaths occurred at home/care home and 50% in acute hospitals in Lincolnshire in 2011 (NHS Lincolnshire). Uncontrolled symptoms and the absence of pre-emptive prescribing are contributory factors which influence whether a patient is able to die in their place of choice and may result in hospital admission.

The Department of Health document published in December 2004 ‘Delivering the Out-of-Hours Review: Securing proper access to medicines in the out-of-hours period’ recommends prompt and easy access to palliative care medicines in the out-of-hours period (action points 8 and 9).

Often towards the end of life patients are unable to take oral medication therefore parenteral administration is required via PRN injection or a syringe driver to control symptoms. This medication needs to be available immediately to the health professional making the assessment of a patient’s condition and subsequent deterioration. Therefore it is recommended that the patient’s GP or a non-medical prescriber (NMP) prescribes medication in advance of deterioration and that these drugs are available in the patient’s home.

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