{
  "abstract": "Background NICE advises an individualised approach to prescribing anticipatory medications (AMs), including consideration of what medications are likely to be required depending on expected symptoms (National Institute for Health and Care Excellence. Care of dying adults in the last days of life. Quality Standard. [QS144]. 2017 [internet]).Aims To determine which AMs are prescribed and administered in patients’ last week of life at home. The clinical indication for giving a medication and cost of ‘wasted’ medications calculated.Methods Community palliative care leads retrospectively collected data for patients (n = 130; 24% of patients who died during this period) who died between September – November 2022 (inclusive). Medications were grouped and analysed in four categories: benzodiazepines, opioids, anti-secretories (AS) and anti-emetics (AE).Results Most patients had appropriate medications in their house in the last week of life (96-100%). 20% patients needed medications ‘re-prescribing’ (primarily due to hospital and community guidance differing). Morphine and oxycodone were the most commonly prescribed opioids. 70% of patients had an opioid and 68% benzodiazepine in their last week of life. 14% were given an AE and only three patients used more than five ampoules. In 94% nausea was a new, not pre-existing, symptom. 33% had an AS and this was used for secretions only (not colic). It was more common to have a syringe driver when closer to death. Most people had 0-5 ‘as required’ (PRN) doses from a particular drug group. Only 11% had more than five PRNs of an opioid (the most commonly used drug group). There was an estimated £4,652.92 in wasted medications. If this is representative of the population it would total £77,548 for all patients over a year.Conclusion A task and finish group was assembled and the following changes were made:Morphine recommended as first line opioid (previously diamorphine).Recommended number of ampoules prescribed reduced to five from ten for AS and AE.Guidance for administering AS updated and a more targeted approach recommended.",
  "authors": [
    {
      "affiliations": [
        "St Gemma’s Hospice, Leeds, UK"
      ],
      "name": "Karen Neoh"
    },
    {
      "affiliations": [
        "St Gemma’s Hospice, Leeds, UK"
      ],
      "name": "Moira Cookson"
    },
    {
      "affiliations": [
        "Leeds Community Healthcare Trust, Leeds, UK"
      ],
      "name": "Amanda Gash"
    },
    {
      "affiliations": [
        "Leeds Community Healthcare Trust, Leeds, UK"
      ],
      "name": "Amanda Parker"
    },
    {
      "affiliations": [
        "Leeds Community Healthcare Trust, Leeds, UK"
      ],
      "name": "Joan Nelson"
    },
    {
      "affiliations": [
        "Leeds Community Healthcare Trust, Leeds, UK"
      ],
      "name": "Sarah McDermott"
    }
  ],
  "title": "P-96 Anticipatory medications – what patients actually use in their last week of life at home",
  "uid": "9cd79992-7fc7-57b6-b41a-951c4a81d60e"
}