BACKGROUND: Hospital clinicians have had to rapidly develop expertise in managing the clinical manifestations of COVID-19 including symptoms common at the end of life, such as breathlessness and agitation. There is limited evidence exploring whether end-of-life symptom control in this group requires new or adapted guidance. AIM: To review whether prescribing for symptom control in patients dying with COVID-19 adhered to existing local guidance or whether there was deviation which may represent a need for revised guidance or specialist support in particular patient groups. DESIGN/ SETTING: A retrospective review of the electronic patient record of 61 hospital inpatients referred to the specialist palliative care team with swab-confirmed COVID-19 who subsequently died over a 1-month period. Intubated patients were excluded. RESULTS: In all, 83% (40/48) of patients were prescribed opioids at a starting dose consistent with existing local guidelines. In seven of eight patients where higher doses were prescribed, this was on specialist palliative care team advice. Mean total opioid dose required in the last 24 h of life was 14 mg morphine subcutaneous equivalent, and mean total midazolam dose was 9.5 mg. For three patients in whom non-invasive ventilation was in place higher doses were used. CONCLUSION: Prescription of end-of-life symptom control drugs for COVID-19 fell within the existing guidance when supported by specialist palliative care advice. While some patients may require increased doses, routine prescription of higher starting opioid and benzodiazepine doses beyond existing local guidance was not observed.
BACKGROUND: Hospital clinicians have had to rapidly develop expertise in managing the clinical manifestations of COVID-19 including symptoms common at the end of life, such as breathlessness and agitation. There is limited evidence exploring whether end-of-life symptom control in this group requires new or adapted guidance. AIM: To review whether prescribing for symptom control in patients dying with COVID-19 adhered to existing local guidance or whether there was deviation which may represent a need for revised guidance or specialist support in particular patient groups. DESIGN/ SETTING: A retrospective review of the electronic patient record of 61 hospital inpatients referred to the specialist palliative care team with swab-confirmed COVID-19 who subsequently died over a 1-month period. Intubated patients were excluded. RESULTS: In all, 83% (40/48) of patients were prescribed opioids at a starting dose consistent with existing local guidelines. In seven of eight patients where higher doses were prescribed, this was on specialist palliative care team advice. Mean total opioid dose required in the last 24 h of life was 14 mg morphine subcutaneous equivalent, and mean total midazolam dose was 9.5 mg. For three patients in whom non-invasive ventilation was in place higher doses were used. CONCLUSION: Prescription of end-of-life symptom control drugs for COVID-19 fell within the existing guidance when supported by specialist palliative care advice. While some patients may require increased doses, routine prescription of higher starting opioid and benzodiazepine doses beyond existing local guidance was not observed.
Entities:
Keywords:
COVID-19; end-of-life care; symptom control
Authors: Bregje D Onwuteaka-Philipsen; H Roeline W Pasman; Ida J Korfage; Erica Witkamp; Masha Zee; Liza Gg van Lent; Anne Goossensen; Agnes van der Heide Journal: Palliat Med Date: 2021-04-07 Impact factor: 4.762
Authors: Aaron K Wong; Lucy Demediuk; Jia Y Tay; Olivia Wawryk; Anna Collins; Rachel Everitt; Jennifer Philip; Kirsty Buising; Brian Le Journal: Intern Med J Date: 2021-09 Impact factor: 2.611
Authors: Gehan Soosaipillai; Anjui Wu; Gino M Dettorre; Nikolaos Diamantis; John Chester; Charlotte Moss; Juan Aguilar-Company; Mark Bower; Christopher Ct Sng; Ramon Salazar; Joan Brunet; Eleanor Jones; Ricard Mesia; Amanda Jackson; Uma Mukherjee; Ailsa Sita-Lumsden; Elia Seguí; Diego Ottaviani; Anna Carbó; Sarah Benafif; Rachel Würstlein; Carme Carmona; Neha Chopra; Claudia Andrea Cruz; Judith Swallow; Nadia Saoudi; Eudald Felip; Myria Galazi; Isabel Garcia-Fructuoso; Alvin J X Lee; Thomas Newsom-Davis; Yien Ning Sophia Wong; Anna Sureda; Clara Maluquer; Isabel Ruiz-Camps; Alba Cabirta; Aleix Prat; Angela Loizidou; Alessandra Gennari; Daniela Ferrante; Josep Tabernero; Beth Russell; Mieke Van Hemelrijck; Saoirse Dolly; Nicholas J Hulbert-Williams; David J Pinato Journal: Ther Adv Med Oncol Date: 2021-09-02 Impact factor: 8.168