Drugs at the End of Life: Does an Integrated Care Pathway Simplify Prescribing?

Abstract

The Liverpool integrated care pathway for the dying patient (LCP) facilitates management of dying patients, but does not provide guidance regarding medication. A retrospective audit was performed of patients using the LCP to assess what medications were required, how requirements changed and which of the four symptoms outlined in the LCP were most troublesome (pain, agitation, sickness and respiratory secretions). Over a five-month period, 68 patients died on the LCP, and were included in the audit. The most unstable symptom (stability defined by rescue medication requirements) at the end of life was agitation − 37 of the 68 patients required regular sedatives and 45 patients needed at least one rescue dose of sedative. Sickness was the most stable symptom − 39 patients needed regular antiemetic, but only three patients needed rescue doses. These findings have implications in writing guidelines for symptom management at the end of life.