New approaches needed to improve end of life care
Researchers supported by CPFT and the NIHR Applied Research Collaboration East of England have proposed new approaches to ensure that patients in the last days of life can access medications to ease their symptoms.
For patients dying in the community, rapid and tailored access to end-of-life medications can be difficult to organise, although these medications can help prevent avoidable suffering in the final days and hours of life.
In their published article for the British Medical Journal (BMJ), the research team led by CPFT honorary nurse consultant in palliative care Dr Ben Bowers recommend that:
"End-of-life anticipatory prescribing can give patients timely access to symptom relieving drugs in their last days and hours, but improved review, provision, and personalisation of medication is needed."
They propose four additional options to help ensure ready access to medications for all patients who need them:
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Resource some community pharmacies to supply end-of-life medications 24 hours a day, seven days a week;
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Enable emergency paramedics to carry end-of-life medication stocks that they can administer to dying patients;
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Trial community healthcare services and nursing homes holding a stock of end-of-life medications;
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Change pharmaceutical regulations to permit end-of-life medications prescribed for one care home resident to be repurposed for another resident, following a medical assessment and individualised prescription (as was permitted during the pandemic).
The research team conclude:
“These options will all need careful piloting and robust evaluation of their clinical effectiveness, safety, unintended consequences and patients’ and families’ views and experiences of care. Taken together, they may not only considerably reduce medication wastage but most importantly help to avoid preventable suffering in the final days and hours of life.”
- Read the full BMJ article
Ben Bowers, Paul Howard, Bella Madden, Kristian Pollock, Stephen Barclay:
Is end-of-life anticipatory prescribing always enough? Opinion, BMJ, 16 May 2023
