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Anticipatory prescribing in community end-of-life care in the UK and Ireland during the COVID-19 pandemic: online survey

Published version
Peer-reviewed

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Type

Article

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Authors

Winterburn, Isaac 
Kelly, Michael P 
Brodrick, Robert 

Abstract

Background: Anticipatory prescribing (AP) of injectable medications in advance of clinical need is established practice in community end-of-life care. Changes to prescribing guidelines and practice have been reported during the COVID-19 pandemic. Aims and objectives: To investigate UK and Ireland clinicians’ experiences concerning changes in AP during the COVID-19 pandemic and their recommendations for change. Methods: Online survey of participants at previous AP national workshops, members of the Association for Palliative Medicine of Great Britain and Ireland and other professional organisations, with snowball sampling. Results: Two hundred and sixty-one replies were received between 9 and 19 April 2020 from clinicians in community, hospice and hospital settings across all areas of the UK and Ireland. Changes to AP local guidance and practice were reported: route of administration (47%), drugs prescribed (38%), total quantities prescribed (35%), doses and ranges (29%). Concerns over shortages of nurses and doctors to administer subcutaneous injections led 37% to consider drug administration by family or social caregivers, often by buccal, sublingual and transdermal routes. Clinical contact and patient assessment were more often remote via telephone or video (63%). Recommendations for regulatory changes to permit drug repurposing and easier community access were made. Conclusions: The challenges of the COVID-19 pandemic for UK community palliative care has stimulated rapid innovation in AP. The extent to which these are implemented and their clinical efficacy need further examination.

Description

Funder: National Institute for Health Research; FundRef: http://dx.doi.org/10.13039/501100000272

Keywords

Original research, 1506, 2474, end of life care, drug administration, home care, terminal care, supportive care, nursing home care

Journal Title

BMJ Supportive & Palliative Care

Conference Name

Journal ISSN

2045-435X
2045-4368

Volume Title

Publisher

BMJ Publishing Group