TY - GEN

T1 - CARer-Administration of as-needed subcutaneous medication for common breakthrough symptoms in home-based dying people in Wales (The CARiAD Package)

T2 - Policy and procedure

AU - Poolman, Marlise

AU - Shuler, Andrew

PY - 2020/3/20

Y1 - 2020/3/20

N2 - The specific practice that this document refers to is that of:▪ Lay (unpaid) carer (friends of family, or healthcare professional [HCP] acting as lay carer for loved one) role-extension, i.e. being trained to competency, to administer▪ Needle-less as-needed subcutaneous (SC) medication via needle-less closed SC catheter, e.g. Saf-T-Intima (as a separate line), for▪ The five common symptoms in the last days of life (pain, nausea/vomiting, restlessness/agitation, noisy breathing/rattle, breathlessness) in those in their▪ Last days of life who expressed a wish to be in their own home when they die.This CARiAD package was explored successfully as part of the National Institute for Health Research (NIHR) Health Technology Assessment (HTA)-funded CARiAD study (HTA project 15/10/37), with one exception: the practice described in this current policy document adds breathlessness to the list of common symptoms. The reason for adding breathlessness is, firstly, that it is described in the NICE 2015 guidelines on care of the dying adult as one of the five common symptoms in the last days of life. Secondly, it is important in the context of the response to COVID-19 infection as the expected mode of death will result from hypoxia, acute respiratory distress syndrome and system failure from overwhelming sepsis. Therefore the palliative management of breathing difficulties will be key in those dying of the infection.The practice described above is legal in the UK (see Appendix, Legal Framework) and is already practiced in some areas in the UK. It is, however, a new practice for most areas in Wales.This document assumes HCPs are following current national guidance on anticipatory prescribing for the last days of life, and will arrange for patients to have the necessary equipment (to administer SC injections) at home. It is noted that this practice is complementary to the use of the Care Decisions for the Last Days of Life guidance.

AB - The specific practice that this document refers to is that of:▪ Lay (unpaid) carer (friends of family, or healthcare professional [HCP] acting as lay carer for loved one) role-extension, i.e. being trained to competency, to administer▪ Needle-less as-needed subcutaneous (SC) medication via needle-less closed SC catheter, e.g. Saf-T-Intima (as a separate line), for▪ The five common symptoms in the last days of life (pain, nausea/vomiting, restlessness/agitation, noisy breathing/rattle, breathlessness) in those in their▪ Last days of life who expressed a wish to be in their own home when they die.This CARiAD package was explored successfully as part of the National Institute for Health Research (NIHR) Health Technology Assessment (HTA)-funded CARiAD study (HTA project 15/10/37), with one exception: the practice described in this current policy document adds breathlessness to the list of common symptoms. The reason for adding breathlessness is, firstly, that it is described in the NICE 2015 guidelines on care of the dying adult as one of the five common symptoms in the last days of life. Secondly, it is important in the context of the response to COVID-19 infection as the expected mode of death will result from hypoxia, acute respiratory distress syndrome and system failure from overwhelming sepsis. Therefore the palliative management of breathing difficulties will be key in those dying of the infection.The practice described above is legal in the UK (see Appendix, Legal Framework) and is already practiced in some areas in the UK. It is, however, a new practice for most areas in Wales.This document assumes HCPs are following current national guidance on anticipatory prescribing for the last days of life, and will arrange for patients to have the necessary equipment (to administer SC injections) at home. It is noted that this practice is complementary to the use of the Care Decisions for the Last Days of Life guidance.

M3 - Other contribution

PB - NHS Wales Health Collaborative

ER -