Remember that the LCP states that:
“The patient has medication prescribed on a “prn” basis for all of the following 5 symptoms ( see below) which may develop in the last hours or days of life.” Remember ‘prn’ means pro re nata (as the circumstances arise) the creators of the LCP have taken this to mean ‘anticipatory’ that is before the symptoms arise.
The LCP lists 5 symptoms in the last hours of life.
- Respiratory tract secretions
- Dyspnoea (Shortness of breath – laboured breathing)
Goal 4.1 (from the LCP documentation).
“Anticipatory prescribing in this manner will ensure that there is no delay in responding to a symptom if it occurs.” This sort of prescribing was pioneered by the Hospice movement and is helpful when appropriate.
In an important paper written by one of our advisory doctors he states from the 2010/ 2011 audit of the LCP that 91% of patients underwent anticipatory prescribing for all 5 categories. Could this be considered ‘appropriate.’
This means that patients got the drugs:
a) Whether or not they were actually dying
b) Whether they needed them or not.
Goal 4.2 (from the LCP documentation).
‘Current medication assessed and non essentials discontinued.’
The audit states that ’88% of interventions, ie medication that people were already on, were stopped.’