Conference Contribution Details
Mandatory Fields
Dukelow Tim, O'Brien Tony, Sweeney Catherine
IAPC 12th Annual Education & Research Seminar 2012
A comparative audit of medication and supplementary fluid use in the last 24 hours of life in palliative care patients dying at home, in hospice and in hospital
Kilkenny, Ireland
Chair Sessions at Symposia
Optional Fields

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.