185 The management of breathlessness in a palliative care inpatient unit

Background Breathlessness is prevalent in patients at the end of their life and the aetiology is often multifactorial. This symptom is distressing for both patients and their families and can be a significant cause of morbidity. Current evidence based regional guidelines recommend the use of non-pharmacological and pharmacological interventions, of which, modified-release opioids are the mainstay. This audit examines how successfully these guidelines are complied with in an inpatient palliative care setting. Methods A retrospective case note analysis collated a list of all patients admitted to the academic palliative care unit (APCU) from 1st October to 30th November 2019. Data on breathlessness management was gathered through the trust’s electronic documentation system and compared with regional guidelines. Results Out of 80 patients admitted to the APCU, 32 (40%) had breathlessness. Of these 32, the most common diagnosis was cancer (not lung primary) at 43.8%, followed by cancer (lung primary) at 21.9%. Around 80% had a reversible cause of breathlessness, all of which were treated. Non-pharmacological options were offered to 68.8% of patients, which was a hand-held fan in 31% of cases. Half of the patients had symptoms of anxiety and of these, 93.8% were offered anxiolytics. Nebulisers were utilised in 50% of patients of which 88.2% were saline. Opioids were suggested for patients who were not already prescribed one. Modified-release morphine and instant-release oxycodone were most commonly used followed by instant-relief morphine. It was common for steroids, oxygen and antibiotics to be used as adjuvant treatment. Conclusion This audit confirms previous findings that breathlessness is a significant symptom in palliative patients. Based on the current regional guidelines, non-pharmacological interventions and modified-release morphine could be offered to more patients. Further discussion through interactive feedback and education is a priority to comply with current guidelines.