Co-led by the BC Centre for Palliative care and First Nations Health Authority, this project developed a consensus statement to guide nursing decision making for people receiving palliative care who need subcutaneous medications for symptom management at home.
The Need
Many people living with serious illness are cared for at home as their illness progresses. Family caregivers play an essential role. When people with life-limiting illness are prescribed subcutaneous medications and are receiving nursing care at home, there are nursing decisions to be made related to the tasks involved in the medications’ preparation and administration.
In Canada, it is common for home care nurses to pre-draw and label subcutaneous medications for family caregivers to administer to people with advanced progressive life-limiting illness at home. However, there is limited evidence to base guidelines for this nursing practice and significant variability in existing guidelines. Some standards specify that medication should only remain in syringes for a short period of time before administration, whereas others guide nurses to consider several related factors in the decision.
Application of standards designed for facility-based care settings or for pharmacy compounding of parenteral medications can profoundly impact the ability for subcutaneous medications for palliative care to be provided within a person’s home.
Partner
- First Nations Health Authority
Provincial Working Group
- Katie Hennessey (Island Health)
- Scott Jones (Vancouver Coastal Health)
- Vicki Kennedy (Interior Health)
- Lara Musa (Vancouver Coastal Health)
- Rachel Neufeld (Canuck Place)
- Sue North (Fraser Health)
- Bella Wang (Fraser Health)
Expert Panel
A panel of 20 clinicians with relevant experience, including nurses (15) and non-nurses (5, including Nurse Practitioner, Physician, Pharmacist)
Project Team
- Della Roberts, Special Projects Manager
- Nicole Wikjord, Clinical Nurse Specialist (First Nations Health Authority)
- Queenie Tsang, Research Associate
- Rachel Carter, Director of Research
- Kathleen Yue, Director of Strategic Initiatives
The Approach
An expert team of nurses, prescribers, pharmacists and family members with lived experience created a consensus statement to address this reference gap.
We adapted a consensus method called the Delphi process, combining input from meetings of a provincial working group and surveys with an expert panel of Clinicians experienced in palliative home care: 13 Nurses, 1 Nurse Practitioner, 2 Physicians, 2 Pharmacists; and focused discussions with 2 people with lived experience of giving medications in a syringe to a person with palliative needs at home.
Informed by a literature review and environmental scan, the provincial working group and expert panel provided their thoughts and opinions of the applicability and importance of identified factors and considerations for the decisions involved with preparing and administering subcutaneous medications for people with palliative needs at home. This information was synthesized by the team and provincial working group into a consensus statement.
The expert statement reached 100% consensus by the panel of clinicians and people with lived experience (n=20).
The consensus statement includes implications for the health system, practice, people living with life-limiting illness and family caregivers, education and research. In addition, the document includes the evidence base and a list of nursing decision-making factors in preparation of subcutaneous medication for people receiving palliative care at home based on consensus of experts.
For more information
Contact Della Roberts at droberts@bc-cpc.ca
