110 From research to policy and practice: impact of a multi-professional multi-organisational research, learning and innovation collaborative to improve community palliative medicines management

<h3>Introduction</h3> Patients, carers and healthcare professionals encounter numerous challenges throughout the multistep processes of medicines management in community palliative care. <h3>Method</h3> A multi-professional, multi-organisational (academic, community, hospice and acute hospital) collaborative was created to share new research, quality improvement work and clinical innovations. and identify priorities for further work. Workshop methods were used to synthesise evidence and expertise into policy and practice recommendations. <h3>Results</h3> Problems occur in community palliative medicines management with decision-making/prescribing; monitoring/supply; use (administration); deprescribing/disposal; and transitions between care settings. These include^{1 2}: Communication about and understanding of medicines Anxiety about medicines hastening death ‘Hidden work’ for patients, carers and professionals to mitigate system gaps Tensions in ‘just in case’ versus ‘just in time’: inappropriate prescriptions and wastage/costs versus timely access if sudden deteriorations occur in or out of hours Resourcing, expectations and experiences of community pharmacists including roles in system, stock and supply issues Delays in effective administration for symptom relief including ‘first dose’ concerns Disposal of unused medicines after death Evidence-based system quality indicators³ and learning from quality improvement work/clinical innovations were synthesised by the collaborative to create recommendations and tools for local and national improvement. Using these throughout community palliative care will help: policymakers prioritise what matters most to patients and carers; guide commissioners in practical approaches to change; healthcare professionals to deliver best practice; patients and carers navigate healthcare systems. Five priorities for further collaborative work were identified: Addressing patients’ and families’ concerns Relationships with community pharmacies⁴ Sharing innovations and best practice regionally/nationally: e.g. ‘permission to give’ protocols⁵; innovations from out-of-hours services Coordination of services across transitions Education/training/support e.g. first dose decisions <h3>Conclusion</h3> Collaboration across academic and clinical settings is effective for evidence-based practice change and shows promise for developing policies to effect system change in the complex area of community palliative care medicine management. <h3>References</h3> Bowers B, Pollock K, Barclay S. Simultaneously reassuring and unsettling: a longitudinal qualitative study of community anticipatory medication prescribing for older patients. <i>Age Ageing</i> 2022;<b>51</b>:afac293. https://doi.org/10.1093/ageing/afac293 Bowers B, Pollock K, Wilkerson I, Massou E, Brimicombe J, Barclay S. Administering injectable medications prescribed in the anticipation of the end of life in the community: A mixed-methods observational study. <i>Int. J. Nurs. Stud.</i> 2024;<b>153</b>:104734. https://doi.org/10.1016/j.ijnurstu.2024.104734 Francis SA and Yardley S. (2024) Getting palliative medication right toolkit: System quality indicators. [Online]. London: Marie Curie Palliative Care Research Department, University College London. [17.10.2024]. Available from: https://www.ucl.ac.uk/psychiatry/sites/psychiatry/files/system_quality_indicators.pdf Health and Social Care Committee (2024) Pharmacy. (HC140, Third Report of Session 2023–24). [Online]. London: Order of the House. [17.10.2024]. Available from: https://publications.parliament.uk/pa/cm5804/cmselect/cmhealth/140/report.html Bowers B, Howard P, Madden B, Pollock K, Barclay S. Is end-of-life anticipatory prescribing always enough? <i>BMJ</i> 2023;<b>381</b>:1106. doi: 10.1136/bmj.p1106. PMID: 37192773. [17.10.2024]. Available