Jennie Pickard, Specialist Palliative Care Pharmacist, St Ann’s Hospice, Heald Green, Manchester, UK, explains the background to a longer article in the May/June edition of the European Journal of Palliative Care.
Over the years I have had numerous discussions, with my colleague, Dr Alison Phippen, about the growing number of medications that hospice inpatients are prescribed. Looking back to when I first started working in palliative care I realise how much has changed.
As clinicians, we have a unified desire to help patients. Obviously, medication can help tremendously with symptom management. However, we need to stop and think . . . “How much does the actual burden of taking medication impact on this person’s life?” In practice, it often appears easier to prescribe than to de-prescribe.
Polypharmacy can be defined as the use of multiple medicines by one person. In the recent literature polypharmacy, in general, has been discussed, 1 however, very little about polypharmacy relating specifically to palliative care has been published. As part of the Improvement Science for Academics (IS4Ac) programme delivered by the Manchester Academic Health Science Centre (MAHSC), we carried out a larger piece of quality improvement work to map polypharmacy at the hospice. We clearly highlighted a problem but could we be certain that patients perceived it as such? After all, perhaps patients would prefer symptoms to be controlled at any cost.
Obtaining patients’ views was therefore important. We investigated how satisfied patients are with their medication. Would they like to take fewer medicines? Do they feel their medicines make them tired? Do they still have some pain despite taking analgesics? Do they find medicines difficult to take or dislike the taste? Does taking medication interfere with their day?
Patients who were able and agreed to take part answered a series of questions in a face-to-face interview. This was repeated six times over a three-week period. This meant some patients would repeat the questionnaire but it was felt that their opinions might change due to changes in their medication regime or clinical condition.
The results showed the majority of patients were satisfied with their medicines (79% of completed questionnaires); however when questioned further, 87% of completed questionnaires indicated the patient would like to take fewer medicines.
The hospice admission documentation now includes a prompt to ask patients how satisfied with their medicines they are. Also a leaflet – Are you taking a lot of medicines? – has been produced. We aim to create opportunities for patients to discuss their medicines with the possibility of reducing them where appropriate.
Further work investigating how polypharmacy in palliative care can be improved is ongoing at the hospice.
Duerden M, Avery T, Payne R. Polypharmacy and medicines optimisation. Making it safe and sound. The King’s Fund Report, 2013.
Read the full article in the European Journal of Palliative Care
This post relates to a longer article, Polypharmacy in an inpatient hospice setting – exploring the patients’ views, by Kathleen Connors, Jennie Pickard, Alison Phippen, Jan Codling, Dai Roberts and Samantha Kay, published in the May/June 2016 edition of the European Journal of Palliative Care (vol. 23.3).
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