Patients in the last days of life at home or in care homes sometimes need fast access to medications to ease their symptoms but new approaches are needed to ensure this happens, say Dr Ben Bowers and colleagues in the BMJ today. For patients dying in the community, rapid and tailored access to last-days-of-life medications can be difficult to organise, although these medications can help avert preventable suffering in the final days and hours of life.
Dr Bowers and his co-authors, who are all experts in end-of-life care, propose four additional options to help ensure ready access to medications for all patients who need them.
resource some community pharmacies to supply end-of-life medications 24 hours a day, seven days a week;
enable emergency paramedics to carry end-of-life medication stocks that they can administer to dying patients;
trial community healthcare services and nursing homes holding a stock of end-of-life medications;
change pharmaceutical regulations to permit end-of-life medications prescribed for one care home resident to be repurposed for another resident, following a medical assessment and individualised prescription (as was permitted during the pandemic).
The research team conclude: “These options will all need careful piloting and robust evaluation of their clinical effectiveness, safety, unintended consequences and patients’ and families’ views and experiences of care. Taken together, they may not only considerably reduce medication wastage but most importantly help to avoid preventable suffering in the final days and hours of life.”
Read the BMJ article
Ben Bowers, Paul Howard, Bella Madden, Kristian Pollock, Stephen Barclay: Is end-of-life anticipatory prescribing always enough? Opinion, BMJ, 16 May 2023
Lucy Lloyd, Communications, Primary Care Unit, University of Cambridge
We are grateful to the Queen’s Nursing Institute for permission to use this image.