Prescribing for End-of-Life Care (EoLC) in the community, at home and in care homes, is a difficult and important area of practice, made even more challenging by the COVID-19 pandemic. Medications for symptom management need to be prescribed and available, often at short notice, in order to ensure that symptoms are quickly controlled, inpatient admissions avoided where not appropriate, and a comfortable death is achieved as far as possible.

One established aspect of end-of-life care practice is “Anticipatory Prescribing”, the prescription and dispensing of injectable medications to a named patient, in advance of clinical need, for administration by nurses or GPs if symptoms arise in the last days of life.

Controlled drugs such as morphine and midazolam are often used in end-of-life care: these powerful drugs are subject to additional legal regulatory controls over and above those for other prescribed medications. The use of such drugs is frequent cause for concern among patients and family members, as well as health and social care staff.

During the COVID-19 pandemic, national guidance was introduced to permit the repurposing of end-of-life care drugs in care homes, such that drugs prescribed and stored for one resident can be repurposed for, and administered to, another resident if urgently needed. This recent and significant change in national medicines management guidance has not yet been studied.

Given the importance of end-of-life controlled drugs and anticipatory prescribing to UK care homes, as well as the significance of medicines repurposing, it is surprising that little to no research exists in this arena.

A study from the University of Cambridge will address this gap. This study will use semi-structured interviews with health and social care professionals to investigate the processes of anticipatory prescribing in UK care homes. This study will address several knowledge gaps in the evidence base for controlled drugs in UK care homes, specifically the processes and perceptions surrounding the prescribing, storage, monitoring, repurposing, administration, disposal of end-of-life anticipatory medicines.

We are currently seeking to interview Care Home Managers, Senior Nurses, GPs and other health and social care professionals involved in the prescribing, storing, administration, or disposal of end-of-life controlled drugs, including anticipatory medicines. ​

Each participant will receive a £30 Amazon voucher. If you are working in a care home and would like to take part, please contact me via email and we will send out more information: mm2426@medschl.cam.ac.uk. Please do get in touch – we’re very excited to hear from you! Follow us on Twitter (@Pelicam and @megmajumder) to stay tuned about our research in the care home medicines space.

This study is funded by the Abbeyfield Foundation.

Team members include:

Megha Majumder, PhD Student in the Palliative and End of Life Care Group at the University of Cambridge

Professor Stephen Barclay, University Senior Lecturer in General Practice and Palliative Care; General Practitioner; Honorary Consultant Physician in Palliative Medicine. Primary Care Unit, University of Cambridge. Honorary Professor of Palliative and Primary Care, University of East Anglia

Professor Kristian Pollock, Professor of Medical Sociology, University of Nottingham

Professor Claire Goodman, Professor of Health Care Research at the Centre for Research in Public Health and Community Care, University of Hertfordshire