Nurses need more support when using anticipatory prescriptions

Our research study found that nurses involved in supporting the use of anticipatory prescribing in the community could benefit from support from the wider clinical teams, including GPs, pharmacists and palliative care specialists. 

By working more closely together, GPs, pharmacists and nurses can build trust and share knowledge and experience to improve the process of anticipatory prescribing.

Anticipatory, or ‘just in case’, prescriptions are now used widely across the UK to manage symptoms common in patients in their last days of life, including pain, nausea and anxiety. They are usually prescribed in advance by GPs, and then dispensed and held in a patient’s home, or their care home, for future use.

Nurses usually play a key role in getting the anticipatory prescription in place and giving the medications to their patients if and when they are needed. Previous research has focused on the role of the GP and the medications to use, so little is known about the involvement of nurses in anticipatory prescribing.

As there’s limited research on nurses’ role in the process, we wanted to find out what nurses think of anticipatory prescribing and how it’s currently used. In our study, we interviewed and observed nurses who provided care for patients with end of life care needs in community settings, and sent out a survey to community nurses in two regions in England. 

What we learned

A total of 575 nurses responded to our survey. 96% of them felt that having access to anticipatory medications helped them to provide good quality end of life care for their patients. The nurses felt it was reassuring that the right drugs were there in people’s homes if needed to relieve pain and other distressing symptoms, quickly and successfully.

By making an anticipatory prescription available in a patient’s home, the nurses had the opportunity to explain to families what it’s used for and this helped them to initiate important conversations on end of life care choices.

Findings from our interviews and survey also highlighted various challenges faced by nurses, including the need for more recognition of their role in anticipatory prescribing. This is because, while many of these nurses recounted good working relationships with their GPs, a small number of them reported issues around some doctors’ reluctance to prescribe anticipatory medicine, prescriptions written incorrectly by doctors, and difficulties accessing the medications they needed.

What it means in practice 

As some of the nurses we contacted felt that they lacked confidence in giving their patients morphine or other controlled drugs commonly used in anticipatory prescribing, having more peer support could help them with their role.

Nurses could benefit from advice and support from the wider clinical teams, including those working in specialist palliative care. Many also valued working in pairs to give anticipatory medications to patients.

By working more closely together, GPs, pharmacists and nurses can build trust and share knowledge and experience. This can improve understanding of their roles and responsibilities in anticipatory prescribing, and improve the anticipatory prescribing process.

It also helps if pharmacies across the country have the right level of stock to fulfil the demand for medications used in anticipatory prescribing whenever they are needed.    

At this year’s annual Marie Curie Palliative Care Research Conference on 19 October, Dr Eleanor Wilson and five other researchers will be presenting their studies on 24/7 care provision, what helps and how it could be achieved to support people living with a terminal illness at home.

If you’re interested in palliative care or are a clinician or researcher, find out more about the conference and how you can register to attend.