A personal experience: Implementing resources to teach carers to give subcutaneous medicines
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A personal experience: Implementing resources to teach carers to give subcutaneous medicines

Changes that improve clinical practice often bring challenges. People may ask why it is necessary - ‘we already have a process that works well.’ It is usual that when the time comes to implement an improved service there are often barriers to overcome. Implementing the Caring Safely at Home (CS@H) resources was no different.

In 2009, Metro South Palliative Care Service and other services in Queensland implemented the Queensland-specific CS@H resources that aimed to support carers to help manage breakthrough symptoms by giving subcutaneous medicines to palliative patients at home. These were new resources at the time and required changes to clinical practice. Prior to this, carers were taught on an ad-hoc basis about how to give subcutaneous medicines.

Some of the barriers from health professionals towards implementation of the standardised resources across Queensland included:

  • Beliefs that it was too onerous to expect carers to prepare and give subcutaneous medicines at home
  • Concerns that carers would make mistakes when preparing and giving medicines
  • An unwillingness to use new CS@H resources because some services already had their own resources for carers to use
  • Concerns that the new Queensland-specific CS@H resources included too many individual resources. 

There is published evidence to allay these concerns and provide reassurance to health professionals.

As we know, carers in Australia can be required to deliver and adjust complex medicine regimens, usually after a sudden decline on a weekend or overnight when there are limited support services available to assist them. 

Carers can feel unprepared for the journey ahead. So, medication management forms a critical component of what carers are expected to manage as end of life approaches. Immediate access to subcutaneous medicines is usually required. If carers are not prepared, and have not acquired the knowledge and skills to respond immediately as symptoms emerge, it is likely the patient will need an often-unwanted admission to an emergency department for symptom management. Interestingly, one of the biggest barriers health professionals had to overcome in 2009 was accepting the need to teach carers how to prepare subcutaneous medicines in the home. 

Evidence supports the need for ongoing carer education and access to quality resources that will support carers with complex symptom management. Additionally, the literature concurs that many carers do not receive adequate training to enable them to competently, safely and confidently manage subcutaneous medicines for symptom control. The evidence also suggests that medication management can be complex for carers. To enable carers to safely and confidently prepare and give subcutaneous medicines as symptom emerge, it is critical to provide carers with consistent education and quality resources, increasing their knowledge and ability to alleviate patients’ distressing symptoms in a timely manner. caring@home resources can be used to provide this education.

The new caring@home project is a great example of how nurses are able to translate evidence-based research into clinical practice, providing quality resources and consistent one-on-one education, that allows for a consistent approach to teaching carers to prepare and give subcutaneous medicines, allowing their loved one to die in the comfort of their own home. We know from the Queensland study that in bereavement, carers said they were pleased they had contributed to the symptom relief of a family member as ‘it was the one thing they could do to help’.

Sue Healy - Masters Nursing - Chronic Disease & Palliative Care; Ba HSc-Nursing; Registered Nurse; Endorsed Midwife

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