PPT74 What a waste: the scandal of anticipatory injections in care homes

<h3>Background</h3> Care homes will soon be the most common setting for UK deaths. It is best practice to have essential medicines available for the final days. Currently medicines are individually prescribed so each home will have multiple sets of injections, and yet if a patient unexpectedly deteriorates, they may not have what’s needed for comfort. A patient who just needed midazolam ended up dying in hospital – this prompted a project team to be established to explore barriers and enablers to holding a small stock of essential medicines in nursing homes. First stage involved auditing current practice. <h3>Method</h3> Audit of 7 nursing homes (390 beds) in Hillingdon, Northwest London to explore number of injections prescribed, used and destroyed January to July 2025 <h3>Results</h3> There were 62 deaths in the 7 homes Number of injections prescribed = 2771 Number of injections used = 89 Total number of injections destroyed in six months 2682 = 98% This includes 543 opioid injections <h3>Discussion</h3> Everybody in the project group was shocked by the number of destroyed medicines. Conclusion holding a small stock in each nursing home would be a win win win. It would lead to relevant medicines being available for everybody should they deteriorate. It would reduce massive wastage. It would save money. It would save nursing time from all the counting needed with the massive number of ampoules currently held. Extrapolated to all of Hillingdon for a year means 16,000 ampoules likely destroyed at a cost of £10,000. Extrapolated to all of UK for a year would mean 4 million ampoules are destroyed at a cost of £2.5 million! <h3>Next steps</h3> 1. Lobby nationally to change legislation to allow nursing homes to hold small stock of relevant medicines, including Schedule 2 opioids without the need for an expensive licence. 2. Prescribe fewer ampoules