63 Review of medication directives in discharges from acute hospital to community palliative care setting

Abstract

Background Medication directives are used by Community Palliative Care Teams (CPCT) to allow planned, safe administration of medications by teams in the community setting for patients with chronic, life-limiting conditions for symptom control (SC) or end of life care (EOLC). This often allows patients to remain in the community and receive care that they may otherwise have had to receive in an in-patient setting. Aims The aims of this project were to assess: Number of patients who were discharged with a medications directive from an acute hospital setting to CPCT; Duration of care under CPCT; Circumstances of any re-admission to acute hospital following discharge with medication directive. Method Review of discharged in-patients to CPCT from Jan – Dec 2017 using hospital palliative care team (HPCT) and CPCT databases and medication directive records, hospital electronic database and patient charts. Review was conducted by one person over a two week period and results were tabulated and analysed using simple Excel format. Results 47 discharges to CPCT with medical directives were identified (38 EOLC, 9 SC). 2 were re-admitted following discharge with EOLC directive, and all 9 SC patients were readmitted (re-admission date range was 1–16 weeks post-discharge). 6 patients discharged with EOLC directive remained under CPCT care at time of review, 3 were discharged from service, with 32 dying under care of CPCT (median days after discharge 8.5). Conclusion Medication directives helped to facilitate 84% of patients discharged from acute hospital to CPCT care to remain at home for EOLC. 100% of SC patients required re-admission but had a varying period in the community prior to re-admission. This clearly demonstrates the importance of medication directives in both HPCT and CPCT for effective palliative care.