Quality improvement project: improving junior doctors' confidence in prescribing at end of life for acute inpatients (2022)

Type of publication:Conference abstract

Author(s):*Dewhirst L.; *Hudson H.

Citation:BMJ Supportive and Palliative Care. Conference: Palliative Care Congress 1 Specialty: 3 Settings – Home, Hospice, Hospital. Telford United Kingdom. 10(Supplement 1) (pp A14), 2020. Date of Publication: March 2020

Abstract:Background Junior doctors are often at the forefront of prescribing for acute inpatients. It is imperative that they are equipped with the knowledge and confidence to prescribe appropriately for patients at the end of their life. We felt that there was reduced awareness of the need for individualised prescribing for patients with relatively common chronic diseases such as Parkinson's disease and epilepsy. Recognising that prescribing end of life medications for patients with such diseases can differ, we looked to improve symptom management by focussing on improving end of life prescribing. Methods A pre-intervention questionnaire was used to assess subjective confidence levels in prescribing anticipatory medications, syringe drivers, and individualised prescribing for patients with Parkinson's disease, end-stage renal disease, epilepsy, end-stage heart failure, and diabetes mellitus. Based on these findings a prescribing handbook was produced, incorporating consultant advice from relevant specialities. Teaching sessions were carried out using case-based discussions alongside the handbook content. A local press release facilitated dissemination of the handbook. A post-intervention questionnaire was then distributed to reassess prescribers' confidence levels. Results Twenty-five allied health professionals (mainly foundation doctors) completed the questionnaires. The preintervention questionnaire found that the majority were confident in prescribing anticipatory medication but were significantly less confident in prescribing syringe drivers and in individualised prescribing. Following formal education and release of the prescribing handbook, higher confidence levels were reported throughout all themes of the questionnaire. Conclusions This quality improvement project has significantly increased prescribers' confidence levels in end of life prescribing. It has also increased awareness of the need for alternative approaches to prescribing for certain individuals and diseases at the end of life. It was stressed that the handbook is to be used as a guide and should not replace the need to escalate concerns to the relevant specialities and the in-house palliative care team.

Link to full-text [NHS OpenAthens account required]