title: Improving the accuracy and turn-around time of controlled drug prescribing for patients being discharged home for end-of-life care.
abstract: Many patients approaching the end of their life express the preference to die at home,[1] although unfortunately the majority of people will still die in hospital.[2] For patients approaching the end of their life, it was noted anecdotally that often those who have expressed a preference to go home from hospital for end of life care may have their discharge delayed due to problems in the prescribing of common medications used to alleviate distressing symptoms at the end of life. An initial audit at Conquest Hospital showed an 89% error rate in these prescriptions, mostly related to prescribing controlled drugs such as morphine and midazolam. A single standardised dispensing chart for commonly prescribed medications at the end of life, in the form of both "Just in Case" medications and syringe driver medications, was created which addressed this problem by having the medications pre-written so as to meet all legal requirements for controlled drugs. The prescriber is able to choose and fill out an appropriate drug and dose by using flow-chart information overleaf and then sign the prescription to allow it to be dispensed. After an initial two month pilot period, a re-audit showed a significant fall in error rate down to 11%, as well as an improvement in turnaround time in dispensing the medications.
authors.affiliation: Conquest Hospital, East Sussex Healthcare NHS Trust, England.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Daniel
authors.affiliation: Conquest Hospital, East Sussex Healthcare NHS Trust, England.
authors.forename: Janki
authors.initials: J
authors.lastname: Patel
authors.affiliation: Conquest Hospital, East Sussex Healthcare NHS Trust, England.
authors.forename: Debbie
authors.initials: D
authors.lastname: Benson