52 What is current practice when using sedative medication at the end of life in a london hospice and teaching hospital? a mixed methods investigation for i-can-care. Issue 3 (1st September 2017)

• Record Type: Journal Article
• Authors: Vivat, Bella; Harrington, Jane; Bemand-Qureshi, Lucy; Davis, Sarah; Stone, Patrick
• Is Part Of: BMJ supportive & palliative care. Volume 7:Issue 3(2017)
• Page Start: A366
• Page End: A367
• Publication Date: 2017-09-01
• Subjects: Palliative treatment -- Periodicals; Terminal care -- Periodicals; 616.029
• DOI: 10.1136/bmjspcare-2017-001407.52
• Languages: English
• ISSNs: 2045-435X

Abstract

Abstract : Introduction: The I-CAN-CARE research programme explores care and assessment of dying patients in two under-researched areas: use of sedative medication at the end of life and prognostication. We present findings from an exploration of current practice relating to sedative use. Aims: To explore the understandings of palliative care physicians and nurses in London regarding use of sedatives, and simultaneously audit deceased patient records for documented sedative use. Methods: Focus groups with experienced palliative care physicians and nurses working in a London hospice or hospital/community-based palliative care were audio-recorded, transcribed, and analysed thematically. Deceased patient notes at both sites were audited independently, working backwards from December 2015 to obtain 25 patients at each site who had received continuous sedation at the end of life. Results: Focus group participants (ten consultants/SpRs; seventeen senior nurses) all said they used sedative medication for managing agitation or distress; aiming for patients to be "comfortable", "calm", or "relaxed", and selecting drugs and dosages as appropriate for patients' individual needs, aiming to start with the lowest doses possible. None used structured observational tools to assess the effects of sedatives; strongly preferring clinical observation and judgement. The audit found usually low dosages: 10 mg/day median continuous dose midazolam; range 0.35–69.5, with written comments often addressing patients' perceived comfort. Conclusions: Focus group participants considered the role of sedative medication as primarily symptom management, emphasising individualised care, and using lowest dosages possible to achieve patient comfort, assessed using clinical judgement. Data from patient records corroborated these qualitative findings.