Purita Choksuwankit – Placement Outcome

A great placement outcome from Purita.


What happens at home when patients are discharged with breakthrough SC medications? Objective 1. To improve colleagues’ awareness of ‘Caring at Home’ project, and on how breakthrough subcutaneous (SC) medications are administered at home. 2. To address how pharmacist counselling can help prevent medication-related issues at home to improve patient care.


Most palliative patients preferred to be cared for at home, and approximately 60-70% of Australians would prefer to die at home.(1, 2) However, less than 10% of Australians were able to achieve this.(3) Subcutaneous (SC) medications for breakthrough symptoms are usually prescribed in advance for palliative patients for management of pain, nausea/vomiting, restlessness/agitation and shortness of breath.(4) If patients have to wait for a healthcare professional to administer these breakthrough medications, the administration can be severely delayed by their travel time to home.(4) Long waits mean that these symptoms are often not adequately managed in the home setting.(4) Failure to control symptoms is a likely cause of patient and carer distress, and it can lead to unwanted hospital admissions.(5) The likelihood of patients remaining symptomatically well managed at home and be able to die at home often depends on the availability of able carers who may be required to administer SC medications.(4, 6)
Successful carer-administration of breakthrough SC medications for palliative patients may help improve patients’ experience by providing rapid symptom control and supporting their wish to die at home.(4) Furthermore, this can help reduce unwanted admissions due to uncontrolled symptoms and their associated costs.(4) It can also help free up community-based palliative care team to address other patients and family’s needs.(4) This will, in turn, result in sustainability of services.(4)
Research shows that with consistent resources, training, and support from healthcare professionals, carers can confidently and competently administer SC medications for the management of breakthrough symptoms.(6-8)
Palliative care services available in the ACT are based at Clare Holland House.(9) The service includes a 19-bed inpatient unit and community specialist palliative care (CSPC) service.(9) Calvary Hospital has been providing pharmacy service to the inpatient unit. However, Calvary Hospital pharmacist’s role for CSPC has been limited to the supply of the Special Access Scheme. Therefore, pharmacists have limited awareness on how palliative care patients are being managed in the community. My activity is to present to my colleagues the ‘Caring At Home’ Project and medication management at home when patients are discharged with subcutaneous (SC) medications.


I conducted a 30-minute presentation on “What happens at home when patients are discharged with SC medications?”. The target audience for my presentation was pharmacy colleagues at The Calvary Public Hospital Bruce, Canberra.

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