Implementing stock end-of-life medication in UK nursing homes

Background In nursing care homes (NCHs), the use of end-of-life care (EoLC) medication has traditionally been requested and prescribed on an individual basis during each resident’s last days of life. However, some GPs are reluctant to prescribe EoLC medication in anticipation of symptoms occurring if, at the time of their visit, the resident is symptom-free. Even when prescribed, care home staff can experience difficulties obtaining the medication out of hours. This can result in residents not having access to appropriate medications when they are experiencing symptoms. Aim This audit aimed to assess the feasibility of NCHs with Gold Standards Framework in Care Homes (GSFCH) accreditation keeping EoLC medications ‘as stock’, rather than having the medication prescribed and dispensed for individual residents when residents became symptomatic. Methods Meetings were held with nurse managers of four NCHs with GSFCH accreditation, local pharmacists and the hospice pharmacist. A strategy to implement the stock medication was prepared. A baseline review of the notes of deceased residents 6 months pre-implementation was undertaken and information regarding symptoms and EoLC medication extracted. The review continued for 6 months after the stock EoLC medication was obtained. Results Three NCHs participated. The notes of 92 deceased residents were examined. Fifty-three per cent of decedents were found to have experienced common EoLC symptoms. The numbers with access to EoLC medication increased once the stock medication was in place. However, some residents still had their own drugs dispensed, despite stock drugs being available. Conclusions There is a need for all dying residents to have access to EoLC medication. The proper facilitation and implementation of EoLC medication ‘as stock’ into NCHs with expertise in caring for dying people could save monies at a time of NHS austerity measures. If the NCHs had relied solely on the stock medication, the reduction in medication waste would have been significant. The introduction of stock medication would also solve problems associated with obtaining medication out of hours. Conflicts of interest: none