CASPS Theme: Health and Society

Keywords: End of life care, Anticipatory prescribing, Care homes

Abstract: Our new paper explores how care home staff collaborate with GPs to prescribe medication for the management of dying symptoms to residents ahead of need. This process is called anticipatory prescribing. The paper reveals that anticipatory prescribing extends the GP's medico-legal authority to make life-altering decisions to care home nurses and senior carers. Therefore, in the care home context, anticipatory prescribing is not only a pharmacological intervention for pain management and symptom control. It is also a mechanism allowing care home nurses and senior carers to decide to forego emergency ambulance care (mostly leading to hospital transfer) and enable palliative care provision and dying in the care home setting. The paper recommends that the timeframe for the GP to review palliative care medication should match the period before death in which a doctor must visit a patient dying in the community in order to release the medical certificate of cause of death (MCCD) without triggering an automatic Coroner’s referral. This period is currently 28 days and was 14 days pre-pandemic.

To cite this paper: Teggi, D., Woodthorpe, K. (2024). Anticipatory prescribing of injectable controlled drugs (ICDs) in care homes: a qualitative observational study of staff role, uncertain dying and hospital transfer at the end-of-life. BMC Geriatrics 24, 310