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Anticipatory or “Just in Case” Medicines in Care Homes Policy

Background

This care service understands that anticipatory medicines are those intended for prompt relief of distressing symptoms for a person who is receiving palliative care for a terminal illness. Anticipatory medicines, which will usually include controlled drugs, will be most frequently used in the last stages of a person’s life. The medicines are made available in advance of their need so that they can be accessed as soon as they are needed.

The medicines will usually be prescribed by the person’s GP or nurse practitioner, for use during the out-of-hours periods when access to the patient’s own general practice and regular pharmacy may not be possible, but immediate relief is required. Anticipatory medicines could cover a range of terminal illnesses or potentially fatal conditions, notably cancer, but also heart, neurological and respiratory conditions.

Anticipatory medicines typically include medication given for pain relief, for sickness or nausea, or for anxiety or restlessness. They are sometimes referred to as “just in case” medicines.

Guidance

Quality standard QS144 Care of Dying Adults in the Last Days of Life, published by the National Institute for Health and Care Excellence (NICE), includes guidance on the use of anticipatory prescribing.

Quality Statement 3 states that 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.

The standard was published to support NICE guideline NG31 Care of Dying Adults in the Last Days of Life (2015).

Policy Statement

It is understood that anticipatory prescribing will make sure that there is a supply of suitable medicines or drugs in {{org_field_name}} with any equipment needed to administer them. They can then be made available to an attending medical practitioner or someone who is authorised to administer them after it has been clinically assessed that they should be given.

{{org_field_name}} recognises that according to NICE guidance (NG31):

NICE further recommends that, before anticipatory medicines are administered, the dying person’s individual symptoms should be reviewed and their individualised care plan and prescriptions adjusted as necessary.

Once prescribed, the medicines belong to the patient and have the same legal status as other prescribed medicines, including controlled drugs.

It is understood that anticipatory medicines are usually supplied in specially marked containers, commonly called “just in case” boxes. The provision of such boxes usually provides good opportunities to discuss with the ill person and others involved in their care the likely process of the illness that could result in their use.

The contents of “just in case” boxes will be decided in terms of individual needs and local agreements and protocols for prescribers and pharmacists. The protocols should indicate such things as:

Implications for a Care Home

Anticipatory medicines in the form of “just in case” boxes might be prescribed when a person prefers to spend their final days in {{org_field_name}} and it has been agreed that they should do so.

It is understood that the medical practitioners involved in a person’s end-of-life care will be responsible for the prescribing and oversight of any anticipatory medicines and for authorising their use. The home will be responsible for their safe storage, security and, where agreed, disposal in line with its medication administration policy and procedures.

The home will note and record that the medicines have been prescribed for the individual person and the details will be recorded on their (end-of-life) care plan. It will also report to the responsible medical practitioners any changes in the person’s condition that could result in permission for the medication to be used.

The plan will state which medicines have been prescribed and under what circumstances they will be used and by who.

The plan should also include any precautions to be taken in relation to any risks involved in their administration.

The medicines will be stored in a secure box or container in a safe place, which should only be opened by a named authorised person or persons when they are needed and after a clinical assessment that they should be used (for example, by a GP or nurse with due authority).

Relevant care home staff will be informed of their existence and availability to the healthcare professionals who can administer them.

If (unusually) it has been agreed that a care home staff member such as a registered nurse should be authorised to use them when needed following a clinical assessment (for example, with this use co-ordinated with a GP by telephone), it must be established in advance that they are competent and trained to use the required medicines and understand the circumstances in which they will be used.

Training

Staff involved in the end-of-life care of a person will be instructed in the purpose and use of any “just in case” medicines and the protocols associated with their administration for the named person.

Care service staff who have been authorised to administer any of the anticipatory medicines will receive specialised training to be specifically competent in their use.


Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

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