Polypharmacy and drug omissions across hospices in Northern Ireland

Polypharmacy and drug omissions (DO) (i.e., drugs prescribed but not administered) may impact on quality of life of hospice inpatients.

The study's objective was to assess for polypharmacy and DO across hospice inpatient units in Northern Ireland (NI).

A retrospective chart review of consecutive admissions to five adult hospices in NI in 2011-2012 was performed. Only regularly prescribed oral and nebulized medications were analyzed.

Inpatient admissions (n=138) were reviewed (58% male, median age 68, 91% had cancer). The average number of regularly prescribed medications was eight (range 0-17) on admission, 10 (1-21) at discharge, and two (0-15) at time of death. Of all prescribed doses, 8.8% were omitted. The most frequent DOs were laxatives (38%), mouth care (11%), and mineral supplements (9%). Reasons for DO included patient refusal (46%), patient asleep or drowsy (20%), and drug not available (7%). DOs numbering 197 lasted 24 to 72 hours. No action was taken by medical staff for 79% of these. DOs numbering 85 lasted over 72 hours. While fewer drug doses were prescribed for patients who died during admission, the proportion of DO was higher (12.4%) than for those discharged (6.9%). DO increased in the last week of life (23%).

Polypharmacy is prevalent among hospice inpatients. Drugs omitted amounted to 8.8%, with the frequency of DO increasing in those who were dying. Documentation justifying DO was lacking. Daily focused drug chart review, pharmacy support, and electronic prescribing may all help to reduce and rationalize medication burden and aid prompt and effective management of DO.