Anticipatory Prescribing/‘Just in Case’ medication in End of Life Care

Anticipatory Prescribing (Just in Case) bags are available across BOB ICS (Buckinghamshire, Oxfordshire & Berkshire West). The Bags are a locally adapted version of a nationally used initiative to make anticipatory prescribing easier. It’s about anticipating the key symptom control problems experienced in the dying phase and ensuring sufficient supplies of anticipatory medication are available in the home before they are needed. The ICB, Hospices, GPs, Pharmacy and Community Nursing representatives have worked together to introduce the Bags throughout the area.

A summary of Community Pharmacy involvement with the Anticipatory Prescribing / Just in Case bag.

Once a patient has been identified as being suitable to have a Anticipatory Prescribing (Just in Case) Bag in the home, their GP will issue an FP10 prescription and supply an ‘empty’ Bag to the patient or patient representative.

Supply of medication

1. The Prescriber will complete the FP10 prescription for the required medication – there is a suggested list of:

• Morphine (or other opioid if alternative more appropriate) for pain control or dyspnoea.
• Metoclopramide (or other antiemetic if more appropriate) for the relief of nausea and vomiting.
• Midazolam (10mg/2ml) for the relief of anxiety, agitation or restlessness.
• Hyoscine butylbromide for the relief of noisy breathing
• Haloperidol for the relief of hallucinations or delirium (or nausea and vomiting).  NB: If Haloperidol unavailable – Levomepromazine can be used as an alternative.
  The drugs and doses are tailored to the patient and may vary.

2. The prescription will then be sent via existing channels to the patients chosen pharmacy, dispensing doctor or signposted to another pharmacy if stocks are not readily available.
3. The patient or representative will present to the pharmacy with the ‘empty’ Bag for filling.
4. The medication will be dispensed in accordance with current legislation which will include the labelling of medication with the directions indicated on the prescription, and placed in the Bag
5. The Pharmacist is asked to complete the Label on the Bag with the earliest Expiry Date.
6. The Patient Information Leaflet (PIL) for each medication will be included in the Bag for each dispensed medication. There is also a Patient Information Leaflet regarding Anticipatory Medication included in the Bag.

Disposal of medication from Just in Case Bag.

Where the medication is within its original, dispensed container and the medication is no longer required, the healthcare professional will advise the medication be returned to a pharmacy or dispensing practice for disposal in the usual way.