University of Hertfordshire

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Original languageEnglish
JournalBMJ Supportive & Palliative Care
Publication statusSubmitted - 30 Jun 2022

Abstract

Abstract
Background. Controlled Drugs (CDs) such as opioids and midazolam are commonly used in end-of-life care symptom management for care home residents.

Aim. To review the published evidence concerning the prescribing, storage, use and disposal of CDs for end-of-life care for care home residents in the United Kingdom (UK).
Design. Systematic review and narrative synthesis. PROSPERO registration CRD42020173014.

Methods. Seven databases (Medline, CINAHL, Embase, PsycINFO, Web of Science, Cochrane Library, and Social Care Online) were searched from January 2000 to January 2021, alongside reference, citation, and journal hand searches. Gough’s ‘Weight of Evidence’ Framework was used to appraise the relevance of studies to the review questions.

Results. The search yielded 1279 titles, from which 125 abstracts and then 42 full text papers were screened. 14 papers were included in the synthesis. Prescribing is primarily by General Practitioners, with administration by nurses. Nurses frequently report feeling inadequately trained in the use of CDs. The storage, monitoring, and disposal of end-of-life care CDs in UK care homes has not been researched to date. The attitudes and experiences of residents and family members regarding these medications also remain unknown.

Conclusion. The current widespread use of CDs for end-of-life care in care homes has a limited evidence base. The lack of research concerning the storing, monitoring, and disposing of CDs, alongside the limited evidence concerning resident and family members’ perspectives, are significant knowledge deficits that require urgent attention.

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