Pre-emptive prescription of medications for the management of potential, catastrophic events in patients with a terminal illness: A survey of palliative medicine doctors

Author:

Katz Naomi T123ORCID,Sacks Bronwyn H1,Le Brian H4ORCID,Hynson Jenny L123

Affiliation:

1. Victorian Paediatric Palliative Care Program, Royal Children’s Hospital, Melbourne, VIC, Australia

2. Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia

3. Clinical Paediatrics Group, Murdoch Children’s Research Institute, Melbourne, VIC, Australia

4. Parkville Integrated Palliative Care Service, The Royal Melbourne Hospital, Melbourne, VIC, Australia

Abstract

Background: Distressing and potentially life-threatening events, such as significant external bleeding, may occur in patients with a known terminal condition. These events are often referred to as catastrophic or crisis events. Pharmacological management varies and there is little evidence to guide practice. Aim: The aim of this study was to explore Australasian palliative medicine doctors’ approaches to pre-emptive prescription of medications to manage catastrophic events. Design: Anonymous survey data were collected electronically. Setting/Participants: Australian and New Zealand palliative medicine fellows and trainees were surveyed. Results: Surveys were completed by 121 doctors; 108 (89.2%) who care for adult patients only and 13 (10.8%) who care for paediatric patients or paediatric and adult patients. In all, 74 (61.2%) respondents pre-emptively prescribed medications at least five times per year, and most orders were never administered. Significant visible bleeding and severe, acute airway obstruction were almost universally considered catastrophic events. Many respondents expressed concern about the lack of evidence to guide pre-emptive medication prescription in this setting. Clinicians reported adverse events related to pre-emptive medication orders being available ( n = 30, 24.8%), as well as orders not being available ( n = 61, 50.4%). Conclusion: Our study supports the need for guidelines, as well as formal education programmes for medical trainees and nursing staff about this important area of practice.

Publisher

SAGE Publications

Subject

Anesthesiology and Pain Medicine,General Medicine

Reference27 articles.

1. Crises in palliative care—a comprehensive approach

2. Children’s Health Queensland Hospital and Health Service. A practical guide to palliative care in paediatrics, https://www.caresearch.com.au/Caresearch/Portals/0/Documents/PROFESSIONAL-GROUPS/Nurses%20Hub/Palliative_Care_in_Paediatrics.pdf (2014, accessed 22 August 2017).

3. Terminal Hemorrhage Preparation and Management #297

4. Sedation for the care of patients with advanced cancer

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