58 Anticipatory prescribing practice at a district general hospital: a service evaluation

Background NICE guidelines (NG31, 2015) advise that suitable anticipatory medicines (AMs) are prescribed as early as possible for people likely to need symptom control in the last days of life. To date, there has been limited evaluation of this practice. This study aimed to characterise anticipatory prescribing (AP) at a district general hospital in relation to three main areas: patient population, outcomes, and prescribing and administration patterns. Methods A retrospective review of electronic prescriptions and clinical records was undertaken in April 2017. All patients who were prescribed AMs using the hospital electronic AP protocol from 1 st July to 31 st Sept 2016 were identified. Demographic, clinical and outcome data were collected for all identified patients (n=118). Prescribing and administration patterns were reviewed for a representative subsample (n=50). Results 118 patients were prescribed AMs (mean age: 81.2±10.3 years, 63 men). 38 (32.3%) had malignant disease and 49 (41.5%) had inpatient palliative team involvement. 66% (n=78) died in hospital, representing 49.7% of all inpatient deaths in that 3 month period. Median time from AM prescription to inpatient death was 1 day (IQR: 0–3). 34% (n=40) of those prescribed AMs as an inpatient were discharged. Of these, 33 (82.5%) had died within 6 months, a median of 8 days (IQR: 4–26) after discharge; AMs were omitted from the discharge prescription in 30%. For the 50-patient subsample, AMs were administered in 54% of cases, usually within a few hours of death. Conclusions There appeared to be an appropriate rate of AP but prescribing patterns suggest a reactive rather than anticipatory approach, with some lack of continuity between inpatient and discharge prescriptions. More education and research are needed to support earlier identification of those in need of AP and smoother transitions between the inpatient and community setting.