Pre-emptive prescription of medications for the management of potential, catastrophic events in patients with a terminal illness: A survey of palliative medicine doctors

• Published in: Palliative medicine Vol. 33; no. 2; pp. 178 - 186
• Main Authors: Katz, Naomi T, Sacks, Bronwyn H, Le, Brian H, Hynson, Jenny L
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-02-2019; Sage Publications Ltd
• Subjects: Airway management; Bleeding; Critical incidents; Drugs; Educational programs; Life threatening; Medical education; Obstruction; Palliative care; Patients; Pediatrics; Physicians; Polls & surveys; Professional practice; Terminal illnesses; Trainees; airway obstruction; Palliative care; catastrophic; haemorrhage; cancer; crisis
• ISSN: 0269-2163; 1477-030X
• DOI: 10.1177/0269216318809668

Background:
Distressing and potentially life-threatening events, such as significant external bleeding, may occur in patients with a known terminal condition. These events are often referred to as catastrophic or crisis events. Pharmacological management varies and there is little evidence to guide practice.
Aim:
The aim of this study was to explore Australasian palliative medicine doctors’ approaches to pre-emptive prescription of medications to manage catastrophic events.
Design:
Anonymous survey data were collected electronically.
Setting/Participants:
Australian and New Zealand palliative medicine fellows and trainees were surveyed.
Results:
Surveys were completed by 121 doctors; 108 (89.2%) who care for adult patients only and 13 (10.8%) who care for paediatric patients or paediatric and adult patients. In all, 74 (61.2%) respondents pre-emptively prescribed medications at least five times per year, and most orders were never administered. Significant visible bleeding and severe, acute airway obstruction were almost universally considered catastrophic events. Many respondents expressed concern about the lack of evidence to guide pre-emptive medication prescription in this setting. Clinicians reported adverse events related to pre-emptive medication orders being available (n = 30, 24.8%), as well as orders not being available (n = 61, 50.4%).
Conclusion:
Our study supports the need for guidelines, as well as formal education programmes for medical trainees and nursing staff about this important area of practice.