56 Pilot study of syringe driver prescribing practice highlights challenges faced by non-palliative care teams

Background

Data about continuous subcutaneous infusion (CSCI) prescribing is limited.1 This survey reviewed practice in the Surgical Emergency Unit (SEU) 01.08.22 – 03.12.22, using the Pallaborative Northwest guideline.2 It aimed to determine the frequency and indication for CSCIs and to document the initial CSCI prescription.

Methods

Data was collected prospectively, 07.10.22 – 03.12.22 with retrospective data added to increase sample size, 01.08.22 – 06.10.22. Electronic patient records were reviewed, data anonymised, and stored on NHS drives. Data was analysed by all authors. Ethics permission was not sought as the survey examined routine practice.

Results

In 4 months, with greater than 1000 admissions, 26 CSCIs were initiated on SEU; 1 every 5 days. The indication, documented in (31%) or determined from the notes (69%) were; dying patient 61.3%, symptom control 31%, inappropriate prescription 7.7%. All CSCIs contained opioids (73% morphine, 27% oxycodone). The median dose of morphine was 10mg/24 hours (IQR 10mg/24 hours), the median dose of oxycodone was 7.5 mg/24 hours (IQR 10mg/24 hours). 65% of CSCI contained an antiemetic (35% metoclopramide, 23.5% haloperidol, 41% cyclizine), 8% an antisecretory/antispasmodic agent (100% hyoscine butylbromide) and 50% an anxiolytic/antipsychotic (69% midazolam and 31% haloperidol). 77% of CSCIs were advised by the hospital palliative care team (HPCT). Of the other 23%, half were altered or discontinued because of concerns; CSCI not indicated, patient sedated, or concern about dose. Commencing a CSCI was discussed with 23% of patients and 42% of families.

Conclusion

CSCI prescribing on SEU is an infrequent event. Staff need support from HPCTs to guide initiation and medication doses. Initiation of a CSCI provides an opportunity to explore patient and family understanding and involve them in conversations about care. Learning will be fed back to SEU and hospital staff. Further larger scale data collection is planned in deanery to interrogate practice.2