Advance Care Planning - My Wishes, ReSPECT Plan, Anticipatory Medications

Anticipatory prescribing of ‘just in case’ medicines is an important part of end-of-life care, which enables prompt symptom relief at whatever time the patient develops symptoms that cannot be managed by oral medications.

Advance care planning should include anticipatory medicine prescribing. This prevents delays in clinicians administrating by ensuring there is a supply of drugs and administration charts available for use in the patient’s home, for when they are needed.

An audit of PCN prescribing identified a variety of medicines, doses, strengths and frequency were being prescribed. This highlighted a need for recommendations and guidance for generalist prescribers, who may only prescribe anticipatory medicines infrequently.

Generalist and specialist palliative clinicians have collaborated to create an EMIS prescribing protocol and supporting documents, which are designed to improve symptom control for patients who are at End-of-Life, to enable more timely administration, more equitable access and to reduce prescribing and administration errors.

The anticipatory medicine protocol is for use by PCNs and OOH providers in Herefordshire and Worcestershire, or anyone who is prescribing anticipatory medicines for patients in their own home or a community residential setting.

The prescription and prescription chart are generated digitally through EMIS Web, or the protocol can be imported into a compatible system. The protocol at the point of use with the patient, is a paper process and copies of documents are left in the patient’s home.

 

Anticipatory Medicine Protocol

2 Elements

  1. EMIS web or imported prescribing protocol – generates digital prescription & prescription chart to be printed or emailed

  2. Supporting guidance and administration documents - ALL to be printed as a pack and left in patient’s home
    1. Prescriber and Administrator Guidance for Subcutaneous Anticipatory Medications PRN & Syringe Pump
    2. Administration Record for Subcutaneous PRN Medicines
    3. Administration Record for Syringe Pump Medicines
    4. Syringe Pump Observation Chart
    5. Record of Medicine Stock

The prescribed medicines may include a dose range.  Administrators should begin on lowest dose unless instructed otherwise & never administer outside of their competence.  Appropriate training needs to be completed.


Protocol Paper Documents – Version 1.0 in use – ALL NEED TO BE PAPER COPIES IN PATIENT’S HOME

1. Prescription chart for administration of subcutaneous drugs via syringe pump & as required bolus drugs

  • A completed chart is generated through EMIS Web protocol (or systems with protocol imported) - printed at source or emailed to administrator for use in patient’s home. 
  • Prescription chart has 2 sections.  Section 1 – As required drugs & Section 2 – continuous subcutaneous infusion via syringe pump.  Both should always be available to allow prescribing directly onto the chart in the patient's home. 
  • It is the only prescription chart to be used in the community for anticipatory medicines. 
  • Outside of EMIS web or systems that have not imported the protocol, it can be used as an editable pdf or printed as a blank chart to be handwritten.

2. Prescriber and Administrator Guidance for Subcutaneous Anticipatory Medications PRN & Syringe Pump (pages 1-4)

  • Guidance contains information available to EMIS web or imported protocol users around medicines recommendations, links to guidance, pharmacy stockists and Specialist Palliative Care (SPC) contacts details.
  • Guidance should be available in patient’s home to inform administrators & prescribers who do not have EMIS Web protocol access.

3. Administration Record for Subcutaneous PRN Medicines (page 5a & page 5… template for continuation)

  • A new page 5a should be commenced every 24 hours from midnight.
  • Additional pages for the same 24 hours require page numbering – 5 b,c etc.
  • Requested by administrators to allow calculating total dose of medicines easier & reduce administration errors through miscalculation.

4. Administration Record for Syringe Pump Medicines (page 6)

5. Syringe Pump Observation Chart (page 7)

6. Record of Medicine Stock (page 8)


Organisation & Administrators Responsibilities

  • Each organisation will provide training & education to administrators
  • Guidance includes prescribing medicine dose ranges for improved timely symptom control
  • Administrators should not administer outside of their competence
  • The lowest medicine dose range is always selected unless instructed otherwise
  • Support & advice should always be obtained & documented


Patient Information

Anticipatory Medicines Patient Leaflet


Organisation Links to Training