Table 5 Care home staff’s experiences of ICDs administration

ICDs are routinely prescribed (regardless of expected symptoms) but not routinely administered to residents.

“it’s knowing the symptoms of when to use your Just In Case [ICDs] and when not to use it. We’ve got people in terrible pain […] there are people with no symptoms at all, up to the very last day […] Then we don’t use it. There’s no trend [concerning whether and when to administer ICDs], but the trend is that when the GP says that this person is end-of-life, then this paperwork [prescription, administration chart] and this medication [ICDs] are always in place. And that’s our practice.” [Nurse 5]

Most residents die without needing ICDs administered but receiving other types of analgesia.

“a lot of the time they [ICDs] are not needed, but we still have them and then occasionally you do get people [who need them] but most people are already on transdermal analgesia anyway” [Manager 4, who was also a registered nurse]

ICDs are mostly effective in addressing residents’ symptoms

“I’ve never been in the situation when I went to the maximum [dose of ICDs] and the resident was still in pain, or something. […] yeah, usually the maximum prescribed is perfect.” [Nurse 4]

On the rare occurrence that ICDs are ineffective in addressing a resident’s symptoms, senior staff do not seek hospital admission for the resident.

“she was agitated all the time so the district nurse called in [the local hospice team], they ended up coming in about three or four times over a week [before the resident died in the care home]. You can get some who just won’t settle, no matter what drugs you give them, we can’t get on top of the agitation, so they’re thrashing around all the time, that can be difficult for staff who aren’t used to it” [Manager 1]