Introduction: Palliative
care patients generally die in three settings; at home, in hospital or in
hospice. For many reasons, there may exist differences in the care, and more
specifically the pharmacological management, delivered in the last 24 hours of
life depending on which setting patients die in. These reasons include;
different cultures of care, involvement of different professionals depending on
location and logistical problems in the delivery of care.
Aims: To establish if there are differences in the range and
doses of medications administered to palliative care patients in the last 24
hours of life depending on the site of care.
Methods: 283 charts were reviewed (102 hospice, 92 hospital, 89 home). Basic
demographics were recorded. Medications administered in the last 24 hours of
life, their doses and routes of administration were noted, as was the use of
supplementary fluids. Mean doses were calculated and compared between groups.
Results: Significant differences were found between the various settings.
Patients dying at home received an average 3.73 medications in the last 24
hours of life compared to 6.56 in hospice and 5.78 in hospital. Larger mean
opioid doses were found in the hospice setting with patients receiving an
average of 76.38mg (mean equivalent daily doses of oral morphine) compared to
48.15mg at home and 47.29mg in hospital. Antimicrobials, supplementary fluids
and electrolytes and medications for co-morbid conditions were administered
with significantly greater frequency in hospital.
Conclusion: There exist significant differences in medication and supplementary
fluid use between different palliative care settings. Further research is
needed in this area to examine the reasons for this disparity.