Authors (including presenting author) :
Ng NHY(1), End-of-Life Care Link Nurse Workgroup(2)
Affiliation :
(1) Nursing Services Division, United Christian Hospital, (2) Tseung Kwan O Hospital
Introduction :
Well managed pain and other distressing symptoms is one of the determining factors for quality of death and dying globally. Poor venous access is common in patients with terminal illness, when patient can no longer tolerate oral medications, continuous subcutaneous infusion (CSCI) of medications is a well-recognized route to manage pain and other distressing symptoms. Implementation of CSCI of medications via infusion/syringe pump in the Medical and Surgical Departments of Tseung Kwan O Hospital (TKOH) has been commenced since October 2021 and May 2022 respectively.
Objectives :
To review the patients put on CSCI in Medical and Surgical Departments of TKOH.
Methodology :
All patients put on CSCI of medications since implementation till 30 November 2024, were recorded and reviewed.
Result & Outcome :
There were totally 75 and 40 patients put on CSCI in medical and surgical wards respectively since implementation. Overall, 84(73%) were male. Age ranged from 35-101 years with 64% aged 65 and above. 90 (78%) of prescriptions were initiated by PC team. Ca Lung was the most prevalent diagnosis in 20% of patients. Reason of using CSCI of medications via infusion/syringe pump was pain and other symptoms management (68%), patient was unable to take drugs orally (23%), patient with poor venous access (3%), and others (6%). Insertion site used most frequently was outer aspect of upper arms (89%) while anterior abdominal wall (8%). All (100%) of patients had no adverse reaction during administration of CSCI. Duration of using CSCI was from less than 24 hours to 34 days. 17% (medical) and 33% (surgical) were transferred to Haven of Hope Hospital (HHH) while the others stayed and died in TKOH.
Conclusion:
Majority of patients requiring CSCI of medications in acute care setting in TKOH were for pain and other symptoms management and too ill for inter-hospital transfer to HHH in their last journey of life. Implementation of CSCI in non-PC setting was safe for patients not tolerated oral medications, their quality of death and dying can be improved as a result, so as the morale of frontline nurses who are empowered through training to provide CSCI for the dying patients. Promotion of CSCI in other non-PC setting is recommended.
