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Palliative Care – Just-In-Case Boxes

Palliative Care team holding Just In Case Box

Effective and timely symptom control is essential for palliative care patients. For people living with an advanced palliative illness, unpleasant symptoms can sometimes occur such as pain, nausea, anxiety, shortness of breath and noisy breathing. Medicines are sometimes prescribed in advance to manage these symptoms that might happen in the future. This is known as ‘Anticipatory’ or ‘Just-In-Case’ medicines.

To mark Palliative Care Week (10 to 16 September 2023) the Western Trust’s Palliative Care Team has announced they are working towards providing ‘Just-In-Case’ medication boxes, when needed, to all patients receiving community based palliative care by early 2024.

Marie Donnelly, Western Trust Palliative Care Facilitator, explains the ‘Just-In-Case Box’ initiative:

“Although this is a relatively new care initiative being rolled out across the Western Trust, it is not a new concept. Just-In-Case Boxes are utilised across the UK and are recognised as best practice by the National Institute for Health and Care Excellence (NICE).

“Just-In-Case medicine involves prescribing ‘as required’ medicines for symptom control in advance of their need. This helps to ensure they are available to relieve symptoms as soon as they occur, and can reduce delays in accessing medication, especially out-of-hours. It can also avoid a visit to hospital, as the medicines required are in the right place at the right time, for the patient.

“A District Nurse, along with a GP will decide when it is appropriate to introduce these medicines. Using the Western Trust Just-In-Case Booklet to access regional guidelines, the GP will decide what the best medicines are for the patient. The District Nurse will keep the patient and their families informed throughout the entire process and advise them of the next steps, should the medications be needed.”

Marie added:

“We worked closely with our Community / District Nursing, Pharmacy and GP colleagues, and a Working Group was established to undertake a pilot of the Just-In-Case Boxes, initially in Irvinestown and Aberfoyle GP Practices. As the pilot was part of a Quality Improvement Project, this helped guide us to understand the challenges, remove any barriers and share learning together. Most importantly we involved our patients with the design and development of this new service. Their wishes, and the feedback from their families, has been invaluable. It has given us the validity to take this forward across the Trust.”