71 ‘Is this a conversation about death?’ planning for future care with patients with advanced cancer: examining the feasibility of using the trajectory touchpoint technique for advance care planning. A qualitative study

Abstract

reviewed by Palliative Care team and compare the results with best practice guidance and the Gosport. Methods The audit cohort was consisted of all patients who died in CCC between July 2018 and December 2018. 29 deaths were identified. Electronical medical records and paper prescription charts were reviewed regarding opiates and sedatives. Results 84% of patients reviewed was not opioid na¯ve on admission. 80% of patients were commenced on syringe driver during admission. Commencement of syringe driver was justified in 96%. In the remaining 4%, syringe driver use was appropriate, but it was not justified. Starting and finishing doses of opiates in syringe drivers were variable, whereas PRN opiate prescription was appropriately dosed in all cases. In 2 cases where the conversion was not according to the guidelines, rationale was given. Similar results were retrieved regarding midazolam prescription. Midazolam was prescribed in 90% cases in patients with syringe driver. Doses of midazolam in syringe driver ranged from 5 mg to 60 mg with appropriate justification of doses. There was no direct correlation between commencement of syringe driver and death. In 100% of cases, clear adherence to the clinical guidelines was shown. Conclusion Current practice in prescribing opiates/sedatives and commencement of syringe driver is according to the clinical guidelines and dosing is appropriate. Results of this audit compared with results produced by the Gosport Independent Panel provide assurance about current use of these medications at CCC. Nevertheless, continuous training is necessary for prescribers in order to maintain the reassuring results.