The decision to receive palliative care at home brings with it the complexity of managing a medication regime. Effective symptom control is often directly linked to medication management and relies on access to medications at all times. In home-based palliative care practice, polypropylene syringes of medications may be drawn up and left in clients' domestic refrigerators for subcutaneous administration by carers to provide immediate relief for symptoms such as pain and nausea. However, although there has been some discussion in the literature about the need for ready access to medications for symptom control of clients receiving care in the community, the feasibility of this practice has received scant attention. The aim of this article is to present the carers' experiences of administering medications in this manner.

Semistructured interviews with 14 carers, who were administering medication in a home-based palliative care setting, were analyzed using qualitative methods to develop meaning units and themes.

Interviews revealed that this practice was highly valued. The carers willingly assumed the responsibility of medication administration, as it allowed the clients to remain at home where they desired to be. They could provide immediate symptom relief, which was of utmost importance to both the client and carer. The carers were empowered in their caring role, being able to participate in the care provided, rather than standing on the sidelines as helpless observers. Carers acknowledged the security and ethical issues associated with the presence of certain medications in the home and valued the 24-h telephone support that was available to them. After clients had died, the carers reflected on their involvement in care and felt a sense of pride and achievement from administering medications in this way because they had been able to care for their loved ones at home and fulfill their wish to die there.

These interviews confirm the feasibility of this practice, which is a component of quality end-of-life care.

A study was done with EMS personnel to determine the ease of use and accetance of a saline lock (SL), intermittent infusion device in place of traditional intravenous tubing and fluid bags for prehospital intravenous (IV) maintenance.

Saline lock, intermittent infusion device use in specific clinical scenaios is easier, less expensive, and as effective traditional TV tubing and fluid bags. The emergency medical technician-paramedic (EMT-P) would accept the implementation of saline locks in the emergency medical servics (EMS) system.

This was a prospective, non-blinded study with the EMS providers under the medical command of a suburban community hospital's emergency department. Patients were included if prophylactic IV access or medication administration was required by clinical protocols. Excluded from the study were those patients requiring IV access for fluid infusion, constant drug infusion, cardiac arrests, or transport to another hospital's emergency department (ED). Intravenous access was achieved with the usual catheter over needle cannulation techniques. The device (Interlin Injection Site SL) was attached to the hub of the IV cannula and flushed with 2 cc of 0.9% saline from prefilled carpujects.

There were completed questionnaires for 79 successful SL initiated in 98 attempts of IV access on 80 patients over a four-month period. When compared to traditional IV fluid bags, SL were judged by the paramedics to be less time-consuming to initiate and maintain (55 of 79 or 70%), easier to use (51 of 79 or 65 %) and facilitated patient transportation (73 of 79 or 92%). Medications were administered according to protocol or command dirtion in the prehospital setting through 20 (25%) SL. Intravenous access was maintained by 52 of 79 SL (65 %), and seven (9%) SL were converted to fluid infusions in the prehospital setting after contact with the medical command physician. In the ED, two (3%) SL were judged by nurses to be nonpatent and 17 (22 %) were converted to maintenance fluid infusions. Systemwide use of SL was favored by 73 of 79 (92.4%) EMS providers. Each device and 2 ml 0.9% saline flush carpuject cost [U.S.]$1.62 versus the cost of IV tubing and a 250 cc bag of lactated Ringer's at $2.11, resulting in a cost savings of 23.2%.

The saline lock, intermittent infusion device is an effective method of maintaining prehospital IV access. When compared to traditional IV fluid bags, EMT-Ps judged the device to be easier and less time-consuming to initiate, and facilitated patient transportation. A cost savings was realized when SL usage was compared to traditional IV fluid bag infusion. Systemwide implementation of the saline lock was desired.