1 40 3 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource July 2024 List Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Citation List Month July List 2024 URL Address <a href="http://doi.org/10.1136/bmjpo-2024-NPPG.52" target="_blank" rel="noreferrer noopener"> http://doi.org/10.1136/bmjpo-2024-NPPG.52</a> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Paediatric Palliative Care and Anticipatory Prescribing: Just Wasteful Are We? Publisher An entity responsible for making the resource available BMJ Paediatrics Open Date A point or period of time associated with an event in the lifecycle of the resource 2024 Subject The topic of the resource child; Palliative Care; adult; controlled study; female; human; major clinical study; retrospective study; palliative therapy; terminal care; time of death; medical record review; opiate; conference abstract; drug therapy; ketamine; national health service; cost benefit analysis; reassurance; access to medication; best practice; carbon dioxide equivalent; levomepromazine; macrogol 3350; midazolam; pharmacoeconomics Creator An entity primarily responsible for making the resource Patel B Description An account of the resource Aims A fundamental right for patients and their families presented with life-limiting condition, is maintaining choice, in terms of place of care and of death, with evidence to suggest that most patients and their families would prefer home.1 Numerous studies have sought to evaluate patient and family preference for choice of place of care and death as well as factors that may influence this choice.2 3 These studies, however mostly focus on offered place and the narrative dialogue that influences choice. No studies have looked how access to medications may impact the choice, or even if factored into discussions. Despite this lack of data, anticipatory prescribing is deemed a hallmark of effective end of life care for children as well as adults. Anticipatory prescribing is recommended practice by NICE guidance (NG31) as well as CQC standards. International consensus also recommends anticipatory prescribing as best practice, all despite the practice being seemingly underpinned by clinical perception rather than evidence, with anticipatory prescribing providing reassurance, that medicines for symptom management are available at time of need, often be out-of-hours. Medication often prescribed in an anticipatory manner include high risk medications. Research from adult palliative care suggest that of those medicines anticipatory prescribed. 40 to 54% go unused.4 To date there has been no similar assessment in paediatrics or potential medications wastage. We conducted a retrospective chart review to determine whether anticipatory prescribing of medicine was cost effective. Method A retrospective chart review of patients referred to paediatric palliative care team at Great Ormond Street Hospital was conducted over an 8 month period. Charts were reviewed to identify those who died with a pre-emptive symptom management plan at death. Charts were then assessed to determine what medication was administered at time of death, in the last week of life of life and compared to the medication pre-emptively requested on management plans. A cost analysis was conducted, of medication requested compared to medication used, pricing of medicines was based on NHS indicative price or drug tariff price. Results 69 patients died in the study period, only 43 died with a management plan. 3 patients were not included in the analysis. Most frequent enteral medicines used were opioids (57.5%), midazolam (37.5%), movicol (17.5%), ketamine/glycopyronium (15%). The most frequent injectable medicines used were opioids (81%), midazolam (59%), levomepromazine (11%). On average at end of life we identified that the total drugs cost for all drugs requested and dispensed was 33,692.28. The total cost of all drugs used was 7,966.76. The total cost of medication wastage was 25,708.79. Conclusions Nationally and internationally, that anticipatory prescribing for end of life care in both adults and children, is recognised as best practice. However, this is not based on any level of evidence. Our retrospective chart review suggests that anticipatory prescribing in paediatric palliative is not a cost effective use of medication potentially costing the NHS in excess of 25,000 per year, and an urgent systems review required. This waste represents an environmental cost of 3,875 grams of CO2e over the 8 month period. Identifier An unambiguous reference to the resource within a given context <a href="http://doi.org/10.1136/bmjpo-2024-NPPG.52" target="_blank" rel="noreferrer noopener">10.1136/bmjpo-2024-NPPG.52</a> Rights Information about rights held in and over the resource Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s). 2024 access to medication Adult Best Practice BMJ Paediatrics Open carbon dioxide equivalent Child conference abstract Controlled Study cost benefit analysis Drug Therapy Female Human July List 2024 Ketamine levomepromazine macrogol 3350 Major Clinical Study Medical Record Review Midazolam national health service Opiate Palliative Care Palliative Therapy Patel B Pharmacoeconomics reassurance Retrospective Study Terminal Care time of death Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource July 2021 List Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Citation List Month July 2021 List URL Address <a href="http://doi.org/10.1007/s00467-021-05056-1" target="_blank" rel="noreferrer noopener">http://doi.org/​10.1007/s00467-021-05056-1</a> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Palliative care for children and young people with stage 5 chronic kidney disease Publisher An entity responsible for making the resource available Pediatric Nephrology. Date A point or period of time associated with an event in the lifecycle of the resource 2021 Subject The topic of the resource advance care planning; conservative management; kidney failure; palliative care; Stage 5 chronic kidney disease (CKD 5); symptom management Creator An entity primarily responsible for making the resource Craig F; Henderson EM; Patel B; Murtagh FEM; Bluebond-Langner M Description An account of the resource Death from stage 5 chronic kidney disease (CKD 5) in childhood or adolescence is rare, but something that all paediatric renal physicians and most paediatricians will encounter. In this paper, we present the literature on three key areas of palliative care practice essential to good clinical management: shared decision-making, advance care planning, and symptom management, with particular reference to CKD 5 where kidney transplant is not an option and where a decision has been made to withdraw or withhold dialysis. Some areas of care, particularly with regard to symptom management, have not been well-studied in children and young people (CYP) with CKD 5 and recommendations with regard to drug choice and dose modification are based on adult literature, known pharmacokinetics, and clinical experience. Copyright © 2021, Crown. Identifier An unambiguous reference to the resource within a given context <a href="http://doi.org/10.1007/s00467-021-05056-1" target="_blank" rel="noreferrer noopener">10.1007/s00467-021-05056-1</a> Rights Information about rights held in and over the resource Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s). 2021 Advance Care Planning Bluebond-Langner M conservative management Craig F Henderson EM July 2021 List Kidney Failure Murtagh FEM Palliative Care Patel B Pediatric Nephrology. Stage 5 chronic kidney disease (CKD 5) Symptom Management Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource May 2021 List Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Citation List Month May 2021 List URL Address <a href="http://doi.org/10.1016/j.jpainsymman.2021.02.007" target="_blank" rel="noreferrer noopener">http://doi.org/​10.1016/j.jpainsymman.2021.02.007</a> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Long-Term Daily Administration of Aprepitant for the Management of Intractable Nausea and Vomiting in Children With Life-Limiting Conditions: A Case Series Publisher An entity responsible for making the resource available Journal of Pain and Symptom Management Date A point or period of time associated with an event in the lifecycle of the resource 2021 Subject The topic of the resource aprepitant; life-limiting; nausea; palliative; pediatric; vomiting Creator An entity primarily responsible for making the resource Patel B; Downie J; Bayliss J; Stephenson A; Bluebond-Langner M Description An account of the resource Background: Nausea and vomiting is a common symptom in children through their end of life journey. Aprepitant, a NK-1 antagonist, has become a potent weapon in the fight against chemo-induced nausea and vomiting. However, its use in palliative care for refractory nausea and vomiting has been limited due to limited experience or evidence of continuous use. Emerging evidence suggests that continuous use is not only safe, but also effective in patients with nausea and vomiting refractory to multiple lines of antiemetic therapy. Method(s): We conducted a single centre retrospective chart review of children receiving care from a specialist palliative care team who were given continuous daily aprepitant for nausea and vomiting and were unresponsive to at least two prior lines of antiemetic therapy. Parental reports of the impact of nausea on mobility and feeding were used as proxy efficacy markers. Duration of effect and toxicity was also evaluated. Result(s): Ten children (eight with cancer as a primary diagnosis and two with noncancer diagnoses) received continuous aprepitant and all showed resolution of nausea and vomiting and an increased ability to mobilize and tolerate feeds. No adverse events noted. Conclusion(s): Our review suggests a role for aprepitant in management of refractory nausea and vomiting, demonstrating safety and efficacy. This case series is the first report of aprepitant use in this manner in the paediatric palliative care setting. Copyright © 2021 The Authors Identifier An unambiguous reference to the resource within a given context <a href="http://doi.org/10.1016/j.jpainsymman.2021.02.007" target="_blank" rel="noreferrer noopener">10.1016/j.jpainsymman.2021.02.007</a> Rights Information about rights held in and over the resource Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s). 2021 aprepitant Bayliss J Bluebond-Langner M Downie J Journal of Pain and Symptom Management Life-limiting May 2021 List Nausea Palliative Patel B Pediatric Stephenson A Vomiting