Objective: Palliative medication kits for home use were developed in order to extend the period of time terminally ill patients might be cared for in their homes.
Design: Kits containing medications that could be used when the oral route was lost, targeting common symptoms that result in hospital admissions, were placed in homes of terminally ill patients.
Setting: Regional health authority, urban setting, community-based palliative care.
Population: Patients receiving care in the community, anticipated to die within the next 2 weeks and wishing to be cared for at home as long as possible.
Intervention: Kits were used when patients were experiencing symptom escalation or crisis, and the drugs to manage these were otherwise not available. Community palliative care nurses recommended when to open the kit and received verbal orders from the supervising palliative care physician for the medications to be administered.
Main outcome measures: Number of kits placed and opened and the prevalence of home death in those instances; the number of kits placed and not opened and the prevalence of home death in those instances.
Results: From 2002-2007, a total of 293 kits were placed in patients' homes and used. Two hundred fifty-eight patients (88%) died at home, compared to 24% who died outside of an acute care setting across the entire program (chi(2) = 579.71; p < 0.0001). In 2006-2007, 73 kits were placed but not used. Forty-four patients (60%) died at home, compared to a program home death rate of 27% (chi(2) = 60.70; p < 0.0001).
Conclusions: Palliative medication kits are a simple and effective way of anticipating and addressing comfort and symptom control for dying patients being cared for in the community. These kits can avert institutional crisis admissions, extend the period of time patients can be cared for in their homes and may increase the likelihood of a home death.