Anticipatory Prescribing Guidelines

Introduction

The Priorities of Care (2014) provides an individualised focus to the care of patient’s recognised as dying in hours and days. The priorities approach has been implemented at ASPH. Health care professionals use these priorities to ensure individualised care to dying patients. The fifth priority of care is ‘Plan and Do’. ‘Plan and Do’ requires staff to proactively develop a care plan individualised for each dying person. One section in ‘Plan and Do’ is the attention to detail of current symptoms and anticipated symptoms. As part of this approach, it is essential to ensure safe and effective management of symptoms in the last hours or days of life. Non-pharmacological methods of symptom management are an important part of high-quality care at the end of life, for example, re-positioning to manage pain. However, this is not addressed in this guideline.

This guideline focuses on the pharmacological management of common symptoms in the last hours/days of life and includes general recommendations for non-specialists prescribing medicines to manage these symptoms.

This guidance supports ASPH to deliver Quality statement 4 of the NICE QS 144 published in March 2017: ‘Adults in the last days of life who are likely to need symptom control are prescribed anticipatory medicines with individualised indications for use, dosage and route of administration.’

A recognised approach to ensure this for all dying adult patients is the practice of anticipatory prescribing. Anticipatory prescribing is designed to enable prompt symptom relief at whatever time the patient develops distressing symptoms, and is based on the premise that, although each patient is an individual with individual needs, many acute events during the palliative period can be predicted and management measures put in place in advance.

Anticipatory medicines are medications prescribed in anticipation of symptoms, designed to enable rapid relief at whatever time the patient develops distressing symptoms. Drugs prescribed in anticipation may include previous or current prescriptions, sometimes with a change in the route of administration, and newly prescribed drugs for anticipated new symptoms.

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