What amount of medicine and utensils are needed for acute, basic End-of-Life palliation? An observational cohort study

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Abstract
Introduction: End-of-Life (EOL) care is essential for alleviating patients' suffering in their final days. An Acute Basic Palliation Concept (ABPC) includes a checklist for doctors and nurses, patient information materials, a medication box, and a decision-making tool for municipal nurses. The concept was developed to support patients, relatives, and healthcare professionals in relieving suffering in elderly, frail, and terminally ill patients, who prefer to die at home. The aim of this study was to investigate the amount of medication and utensils necessary for EOL care when using the ABPC on patients without specialized palliative needs and a life expectancy of days. Methods: This observational study was conducted in the North Denmark Region. Forty dying patients were discharged from the emergency departments using the ABPC, which included a pre-packed box of medicine and utensils for EOL care. When the patient had passed away, the boxes were collected, the remaining medication and utensils counted, and the used medicine calculated. Results: The remaining contents of 32 out of 40 boxes were counted after the completion of the patient-treatment process. The last eight boxes had been sent for destruction by the healthcare staff. Median time to death was 2.0 (1;3) days, mean age was 85 (standard deviation 9.4) years, and 69% were women. Availability of 20 vials of Morphine (10 mg/mL), 18 vials of Midazolam (5 mg/mL), four vials of Haloperidol (2.5 mg/mL), six vials of Glycopyrronium (0.1 mg/mL), and six suppositories of Bisacodyl (10 mg), was sufficient for covering the needs of 95% of the patients receiving EOL care. Conclusions: The number of medication vials needed for EOL care in 95% of patients without special needs was documented in this study of 32 patients.

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