Online Article: End of life care in Covid-19 - an audit of pharmacological management in hospital patients

Hospital healthcare staff have had to rapidly develop expertise in managing Covid-19 symptoms common at end of life, such as breathlessness and agitation. This UK study aimed to establish whether prescribing for symptom control in patients dying with Covid-19 adhered to existing local guidance.  A retrospective review of the patient records of 61 patients referred to specialist palliative care were included.  Intubated patients were excluded.  Findings showed 83% of patients were prescribed with opioids at a starting dose consistent with local guidelines.   The paper concluded that while some patients may require increased doses, routine prescription of higher starting opioid and benzodiazepine doses beyond local guidelines was not observed

Jackson, T. et al. 2020.  End of life care in Covid-19 - an audit of pharmacological management in hospital patients.  Palliative Medicine, 34 (9) p 1235-1240.

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Article: Medication use in the last year of life: a cross-sectional hospice study

The objectives of this UK study were to: (1) explore medication use among people with life limiting illness receiving hospice care; (2) apply consensus criteria to assess medication appropriateness; and (3) determine the overall pill burden in this patient population.  Six UK hospices in the North- East of England took part.  They found polypharmacy is common in patients accessing hospice care, as is the use of questionable medication.  The pill burden was also high which may be an additional treatment burden to patients.  They concluded holistic deprescribing approaches should be developed and implemented. 

Scullion, L. et al. 2020.  Medication use in the last year of life: a cross-sectional hospice study.  BMJ Supportive and Palliative Care.

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Article: Clinical nurse specialist prescribing in a cancer centre supportive and palliative care team

The aim of this study was to provide insight into the prescribing practice of 3 independent nurse prescribers (INP) working in a district general hospital and a specialist tertiary cancer centre in the UK. A review of all consultations and prescribing activity was carried out over a 3 month period in 2018.  493 consultations were undertaken on 186 individual patients. 247 (50%) consultations resulted in changes to a prescription and 50% of these resulted in the prescribing of an opioid for moderate to severe pain.   The authors conclude this study demonstrated the potential for independent nurse prescribers in this setting to provide comprehensive symptom control.  It also led to the clinical nurse specialists (CNSs) practicing with a greater autonomy, leading to enhanced job satisfaction.  They encourage all CNSs to undergo INP training.

Hall, S. et al. 2019. Clinical nurse specialist prescribing in a cancer centre supportive and palliative care team.  BMJ Supportive & Palliative Care. epub ahead of print.  August 2019.

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