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BMJ Support Palliat Care ; 10(3): 343-349, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-602096

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.


Subject(s)
Caregivers , Drug Administration Routes , Palliative Care/methods , Practice Patterns, Physicians'/statistics & numerical data , Terminal Care/methods , Administration, Buccal , Administration, Sublingual , Analgesics, Non-Narcotic/administration & dosage , Analgesics, Opioid/administration & dosage , Betacoronavirus , Coronavirus Infections/epidemiology , Fentanyl/administration & dosage , General Practitioners , Hospice Care/methods , Hospices , Humans , Hypnotics and Sedatives/administration & dosage , Ireland/epidemiology , Lorazepam/administration & dosage , Methotrimeprazine/administration & dosage , Muscarinic Antagonists/administration & dosage , Nurse Specialists , Palliative Medicine , Pandemics , Physicians , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Surveys and Questionnaires , Telemedicine/methods , Transdermal Patch , United Kingdom/epidemiology
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