Understanding the Patient Experience of "as-Required" Medication in a Hospice In-Patient Unit.

BACKGROUND: Timely administration of 'as-required' medication is important for managing patients' symptoms in palliative care. There are no national or local standards around the maximum length of time for the process to administer 'as-required' medication and little in the literature to inform practice. Our aim was to understand the patient experience of receiving these medications in the in-patient setting of a hospice. METHODS: A survey of hospice patients who had been on the ward at least seven days was conducted over a fifteen-week period looking at current practice, the patient experience of requesting medication and how long it took to be administered. RESULTS: Thirty-one responses were obtained. Patients made their requests in a variety of ways but 33% did not use their call bell. When looking at their most recent 'as-required' medication request, 87% of patients estimated that they received it within ten minutes. When considering their longest wait, 16% of patients reported waiting longer than twenty minutes. CONCLUSION: This survey highlights the importance of there being a variety of ways for patients to request 'as-required' medication and staff being proactive with patients to facilitate these requests. Patients perceive nursing staff to be busy and do not want to bother them. Although usually patients get their medication within ten minutes, patients can be waiting more than twenty minutes. There is a need for national standards on time to administer as-required medication within a healthcare setting and a need for more data to inform such a standard.

Farrell valve relieves bloating in gastrostomy patient.

Dysphagia and weight loss are experienced by up to 80% of patients with motor neuron disease (MND). Enteral tube feeding can benefit these patients but side effects including fullness, bloating, diarrhoea and constipation are frequent and can lead to non-compliance. Changes in feed formulation, regimens and the use of prokinetic medication can help symptoms. We describe a case where the use of gastric pressure relief bags during enteral feeding improved symptoms of bloating in a hospice inpatient with MND. Symptoms recurred when these were not used, which were only partially relieved by manual venting of the gastrostomy tube. We suggest that this simple, non-pharmacological approach to bloating may provide opportunities for symptom relief in the palliative care setting.

Identifying, highlighting and reducing polypharmacy in a UK hospice inpatient unit using improvement Science methods.

Polypharmacy, the concurrent use of multiple medications by one individual is a growing global issue driven by an ageing population and increasing prevalence of multi-morbidity[1]. Polypharmacy can be problematic: interactions between medications, reduced adherence to medication, burden of medication to patients, administration time, increased risk of errors and increased cost. Quality improvement methods were applied to identify and highlight polypharmacy patients with the aim of reducing their average number of regular tablets/capsules per day by 25%. The project was delivered within a UK based 27 bedded hospice inpatient unit. A series of PDSA cycles studied interventions focusing on the identification of patients with polypharmacy, the highlighting of these patients to prescribers for review and the views of patients about their medication. For the purposes of the study, polypharmacy was defined as greater than ten regular medicines and/or greater than twenty regular tablets/capsules each day. The interventions tested included patients on regular paracetamol and strong opioids being offered a trial without regular paracetamol, a constipation guide promoting the use of combination laxatives, education of prescribers around dose strengths, checklist of recommendations was placed in case notes and a sticker was used on the medicine chart to highlight patients in need of polypharmacy review. The introduction of a trial without paracetamol and a laxative guide led to reductions in polypharmacy. The sticker and checklist were successful interventions for highlighting patients with polypharmacy. Quality improvement methods were used to plan, try, test and implement simple interventions for patients on the hospice inpatient unit. This has led to a 25% reduction in the average regular tablet/capsules burden , a 16% reduction in the average number of regular medications and a 30% reduction in the average volume of liquid medication per patient without an increase in the use of 'as required' medication or length of stay.