Team keeping fragile patients out of A&E given ambulance service award

The paramedic team behind a new scheme providing essential drugs to frail and end-of-life patients in their own homes has been recognised with an award. The scheme allows specially trained paramedics to carry drugs for frail patients that can be administered (with the confirmation of the patients’ GP or hospice) for:-

• pain
• nausea and vomiting
• agitation/delirium
• excessive secretions
• breathlessness.

The drugs have been chosen in line with national standards and NICE guidance.

They are administered under a Patient Group Direction (PGD) – which allows some health professionals to supply and administer specified medicines to pre-defined patients, without them needing to see a prescriber (such as a doctor). Nicholas Williams, an advanced paramedic in urgent care with East of England Ambulance Service, is project lead for the palliative care PGD. He developed the scheme as part of his MSc in Advanced Professional Practice in 2021.

He said it was born out of necessity: “I saw fragile and frail patients suffering with palliative and end-of-life symptoms in the community who had slipped through the system, and had not been connected with a GP or palliative/hospice team. “Ambulance crews had to rely on communication with out-of-hours and specialist teams to arrange medication. This usually involves a GP to prescribe medication and district nurse or hospice teams to administer them, which can take several hours. “Sadly, many patients passed away in hospital, which was not where they wished to be.”

EEAST has worked with the Hospice of St Francis to develop and deliver bespoke training in palliative emergency care. Before they can administer the drugs, the advanced practice team undergo specific training with the hospice’s clinical team. Seven trial sites were selected around the EEAST region, offering 24/7 cover. Since January this year, 45 patients have been treated and had successful or partial symptom control. All the patients avoided admission to accident and emergency (one was admitted directly onto a ward) and more than 40 have been able to remain at home with a hospice or GP follow up. The team received an award for outstanding patient care at the recent Stars of EEAST awards.

The Palliative and End of Life PGD team are: Nick Williams - Project Lead (Advanced Paramedic), Cliff Dear and Chris Neil (Advanced Paramedics), Tim Hickey (Clinical Lead for Urgent Care), Andrew Cooke (Trust Pharmacist) Amy Godfrey (Medicines Management) and overseen by Dr Simon Walsh (Trust Medical Director).