Palliative care

Click here for the West Midlands Palliative Care Guidelines

Guidance re Anticipatory Drug (‘Just-in-case’) prescribing for patients at the end of life

The Wolverhampton Palliative Care Leads issued the following advice in April 2016

PAIN OR BREATHLESSNESS

For opioid naïve patients, prescribe morphine sulfate 2.5 mg subcutaneously as required, up to hourly, maximum 12 doses in 24 hours

On TTO sheet/ FP10 request:
Morphine sulfate 2.5 mg subcutaneously as required, up to hourly
TOTAL QUANTITY: Morphine sulfate injection (10mg/ml), 1ml ampoules, x 5 (FIVE) ampoules

For patients already taking opioids, prescribe their usual "as required" opioid preparation in a parenteral (subcutaneous) preparation at the appropriate dose. If you are uncertain what dose should be prescribed, contact the palliative care team for advice.

NAUSEA & VOMITING

Prescribe Levomepromazine 5 mg subcutaneously as required, up to every 2 hours, maximum 6 doses in 24 hours

On TTO sheet/ FP10 request:
Levomepromazine 5 mg subcutaneously as required, up to every 2 hours
TOTAL QUANTITY:Levomepromazine injection (25 mg/ml), 1 ml ampoules, x 5 ampoules

RESTLESSNESS/ AGITATION OR BREATHLESSNESS

Prescribe Midazolam 2.5 mg subcutaneously as required, up to hourly, maximum 12 doses in 24 hours

On TTO sheet/ FP10 request:
Midazolam 2.5 mg subcutaneously as required, up to hourly
TOTAL QUANTITY:Midazolam injection (5 mg/ml), 2 ml ampoules, x 5 (FIVE) ampoules

RESPIRATORY TRACT SECRETIONS

Prescribe Glycopyrronium 200 micrograms subcutaneously as required, up to every 2 hours, maximum 6 doses in 24 hours

On FP10 request:
Glycopyrronium 200 micrograms subcutaneously as required, up to every 2 hours
TOTAL QUANTITY: Glycopyrronium injection (200 micrograms/ml), 1 ml ampoules, x 5 ampoules

Note:

SYRINGE DRIVER AUTHORISATION click here for anticipatory prescribing template

OPIOID EQUIANALGESIC DOSE CONVERSION click here for information