Retrospective Evaluation of the Use of Continuous Palliative Sedation and Continuous Opioid Infusion in Hospitalized Patients in End-Of-Life Care

Background Continuous palliative sedation (CPS) and continuous opioid infusion (COI) are two widely used interventions to relief suffering and manage symptoms in the terminal phase. National guidelines exist for both. This study investigated guideline deviations in a hospital setting.Aim The main objective was to assess the prevalence of deviations from the Dutch guidelines for CPS and COI, potentially leading to inappropriate care. The secondary objective was to investigate whether involvement of the palliative consulting team and pain team resulted in less guideline deviations.Design Patient records from hospitalized patients who deceased between December 2022 and December 2023 who received CPS and/or COI as end-of-life care, were retrospectively analysed.Results 101 patients who received CPS and 129 patients who received COI as end-of-life care were included. In patients receiving CPS, clinically relevant guideline deviations were found in 52.5% of patients, mostly related to change in opioid dose of COI during CPS and other opioid-related use during CPS. In 76.7% of the patients with COI, one or more guideline deviations were found. These were mostly related to opioid (starting) dose and use of morphine in patients with impaired renal function. Involvement of the palliative consulting team and pain team resulted in slightly less guideline deviations.Conclusion This evaluation on CPS and COI guideline deviations found one or more deviations in the majority of patients. Further research and training is required to identify methods to improve knowledge and improve the use of the guidelines on CPS and COI as end-of-life care.