Abstract
BackgroundContinuous subcutaneous infusions (CSCIs) are commonly used in the United Kingdom as a way of administering medication to patients requiring symptom control when the oral route is compromised. These infusions are typically administered over 24 h due to currently available safety data. The ability to deliver prescribed medication by CSCI over 48 h may have numerous benefits in both patient care and health service resource utilisation. This service evaluation aims to identify the frequency at which CSCI prescriptions are altered at NHS Acute Hospitals.MethodsPharmacists or members of palliative care teams at seven acute NHS hospitals recorded anonymised prescription data relating to the drug combination(s), doses, diluent and compatibility of CSCIs containing two or more drugs on a daily basis for a minimum of 2 days, to a maximum of 7 days.ResultsA total of 1301 prescriptions from 288 patients were recorded across the seven sites, yielding 584 discrete drug combinations. Of the 584 combinations, 91% (n = 533) included an opioid. The 10 most-common CSCI drug combinations represented 37% of the combinations recorded. Median duration of an unchanged CSCI prescription across all sites was 2 days.ConclusionData suggests medication delivered by CSCI over 48 h may be a viable option. Before a clinical feasibility study can be undertaken, a pharmacoeconomic assessment and robust chemical and microbiological stability data will be required, as will the assessment of the perceptions from clinical staff, patients and their families on the acceptability of such a change in practice.
Highlights
Continuous subcutaneous infusions (CSCIs) are commonly used in the United Kingdom as a way of administering medication to patients requiring symptom control when the oral route is compromised
A pilot study conducted at a large United Kingdom (UK) teaching hospital revealed that in 72% (n = 38) of cases, no medication changes were made to the CSCI within the first 48 h of use [14]
An investigation was undertaken to gather data regarding the frequency at which CSCI prescriptions are altered in Acute National Health Service (NHS) Trusts to identify if there may be a cohort of patients who could theoretically receive a 48h CSCI
Summary
Continuous subcutaneous infusions (CSCIs) are commonly used in the United Kingdom as a way of administering medication to patients requiring symptom control when the oral route is compromised. A pilot study conducted at a large UK teaching hospital revealed that in 72% (n = 38) of cases, no medication changes were made to the CSCI within the first 48 h of use [14] This suggests that in certain circumstances (such as patients with stable palliative care needs), there may be an opportunity to deliver medication over 48 h. Such practice may have numerous benefits in both patient care (improving patient autonomy/ freedom, enabling clinicians more time to focus on providing compassionate care) and health service resource utilisation
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