Benchmarking benzodiazepines and antipsychotics in the last 24 hours of life
Brian Ensor, Daphne Cohen
The use of medications at the very end of life is known to be very variable internationally, particularly regarding medications that can be sedative. Hospices in NZ considered that we needed to find out what variation exists within this country, so that we can start to reflect on our own practice, with the goal of working out why we do what we do. At this stage it is simply finding out the range of current practice, there is no attempt to make any judgements about what is correct prescribing,. There are some expected causes of variation, such as those patients who die in a hospice may have more medication needs than those who die in the community. However there is an additional range of complex factors which may be unique for each hospice, each community and for each patient. The requirements for medications, and the goals for end-of-life care, are variable between people. The important bottom line is that there should be some dialogue and negotiation between patient, family and health professionals about what the goals are, and how medications subserve these goals. This is part of prompting further discussion in NZ about how people wish to be cared for at the end of life.
