Introduction
Anticipatory medicines are defined as medicines that are used in palliative care. These medicines are used to ensure the resident is “comfortable” at the end of life.
In palliative care the resident’s requirements can change at very short notice and to ensure that there is no delay in the supply of the medicines that are required, GPs prescribe medicines and pharmacies supply these in “anticipation” that they are to be required.
Anticipatory medicines could be classified as “controlled drugs” e.g. Morphine injections or they could be non-controlled drugs e.g. Cyclizine injections.
The formulation of these medicines tends to be “injections” for which ATLAS eMAR does not carry out stock control. This means that although you may be able to record the booking in of these medicines, ATLAS eMAR will not count down how many you have left every time you administer one. Instead you will have to keep a manual count, for example in your controlled drug register.
This document therefore provides a guide as to how to manage these medicines using the ATLAS eMAR system.
Processes for managing these medicines on ATLAS eMAR
Prescriptions
Anticipatory medicines are prescribed in the usual way by prescriber's and the prescriptions are sent to the pharmacy.
Dispensing and supply
The pharmacy receives the prescriptions for these medicines and dispenses the medicines in the usual way.
Booking in at the care home
The medicines are delivered to the care home by the usual pharmacy provider and the care home books these medicines in the usual way by scanning the barcodes on the dispensing labels.
If the medicines are controlled drugs, then these will also need to be booked in using the Controlled Drug register. (Controlled Drugs are usually identified by the pharmacy on delivery, OR there is a CD mark on the back of the manufacturers pack)
If the medicine is supplied by another pharmacy, ATLAS eMAR will not record how many have been booked in.
You will have to first input the details of these medicines manually on the resident’s profile on ATLAS eMAR.
If the medicines are controlled drugs, then these will need to be booked in using the Controlled Drug register.
If the medicines are not controlled drugs, then these will need to be booked in using a paper MAR chart.
Reviewing the Therapy and Schedule on ATLAS eMAR
Once the usual pharmacy has dispensed these medicines, the details of the medicines and their administration schedules appear on the ATLAS eMAR device in the usual way on synchronization of the device.
If the medicines have been dispensed by another pharmacy, you will have to input the medicines and their schedule on ATLAS eMAR in the normal way.
In residential homes
In residential homes these medicines are often managed and administered by District Nurses or the area Palliative Care Teams who have their own paper systems for recording administrations of these medicines. Therefore the “Drug settings” on ATLAS eMAR need to be changed and set to managed on “Paper”. It is a policy decision to determine if the care home has to also maintain a record or if the DN uses their own paper system and leaves this record at the care home.
In Nursing Homes
In Nursing homes where the nurses are administering medicines, it may be more appropriate to have a flexible schedule rather than a set schedule. This will then allow the recording of administrations according to the palliative care needs of the resident.
Administering Anticipatory / End of Life / Just in Case Medicines
If the medicines have been dispensed by the normal pharmacy and have a scheduled time of administration, ATLAS eMAR will prompt for these medicines to be administered at the set times. These medicines are therefore administered in the normal way by scanning the barcodes on the instruction labels.
If the medicines have been dispensed by another pharmacy, then there will not be any barcodes on the instruction labels. You would also need to have inputted the administration schedule. Therefore for administration you will be required to “Touch the Screen” on ATLAS eMAR for recording administrations.
If as recommended above these medicines have been set up with a flexible schedule, the ATLAS eMAR device will not prompt you to administer the medicines at specific times. These items will appear with a “white background”. You will be required to choose when to administer these medicines.
If the medicines have been set to be accounted for on paper, they will also appear with a “white background”. No further action is required from you.
Placing prescription requests for Anticipatory / End of Life / Just in Case Medicines
You are required to review the physical stock levels that you have and then place prescription requests in the normal way on ATLAS eMAR.