[Type text] Anticipatory Medication STAT dose and Syringe Driver Guidance [Type text]

Size: px

Start display at page:

Download "[Type text] Anticipatory Medication STAT dose and Syringe Driver Guidance [Type text]"

Barbara Harvey
5 years ago
Views:

1 [Type text] Anticipatory Medication STAT dose and Syringe Driver Guidance [Type text] Patients with egfr greater than 30mL/min Patients with egfr less than 30mL/min Symptom Drug Dose Symptom Drug Dose PAIN Opioid naïve patient PAIN Patient already on strong opioid AGITATION NAUSEA &/OR VOMITING (If in bowel obstruction contact Specialist Palliative Care) CHEST SECRETIONS BREATHLESSNESS Morphine Sulfate for injection 2.5mg 5 mg Subcutaneously (S/C) PRN up to hourly. Up to maximum 6 doses in 24 Contact Specialist Palliative Care Team for advice Midazolam Levomepromazine Glycopyrronium Bromide Morphine Sulfate for injection Midazolam 2.5mg 5mg Subcutaneously (S/C) PRN up to hourly Up to maximum 6 doses in mg Subcutaneously (S/C) PRN Up to maximum 4 doses in micrograms subcutaneously (S/C) PRN Up to maximum 4 doses in mg 5mg Subcutaneously (S/C) PRN up to hourly Up to maximum 6 doses in mg 5 mg Subcutaneously (S/C PRN up to hourly Up to maximum 6 doses in 24 PAIN Opioid naïve patient PAIN Patient already on strong opioid AGITATION NAUSEA &/OR VOMITING (If in bowel obstruction contact Specialist Palliative Care Team) CHEST SECRETIONS BREATHLESSNESS Morphine Sulfate for Injection 1.25mg -2.5mg Subcutaneously (S/C) PRN 2-4 hourly Up to maximum 6 doses in 24 Contact Specialist Palliative Care Team for advice Midazolam Haloperidol (Avoid in patients with Parkinson s disease) Glycopyrronium Bromide Morphine Sulfate for Injection Midazolam 1.25mg 2.5mg Subcutaneously (S/C) PRN 2-4 hourly Up to maximum 6 doses in mg-1mg subcutaneously (S/C) PRN Up to maximum 3 doses in micrograms subcutaneously (S/C) PRN Up to maximum 4 doses in mg -2.5mg Subcutaneously (S/C) PRN 2-4 hourly Up to maximum 6 doses in mg 2.5mg Subcutaneously (S/C) PRN 2-4 hourly Up to maximum of 6 doses in 24 There is a 7 day Specialist Palliative Care Service from 9am 5pm in the community, and 5 days a week in the acute hospital If Specialist Palliative Medicine advice is required in, please contact: Hospital team: / Community team: Weekend community team: option 1 Out of : Palliative Medicine advice via on call nurse / doctor available via Compton Care (previously known as Compton Hospice)

2 [Type text] Anticipatory Medication STAT dose and Syringe Driver Guidance [Type text] If a patient is requiring 3 or more repeated doses of the same drug in 24 then it would be good practice to consider a syringe driver When prescribing a syringe driver please then consider the following: 1) The starting dose of medication should reflect the total of the subcutaneous doses used in a 24 hour period and any regular medication used for symptom control including analgesia, anti-emetics etc. 2) The table below gives some guidance when starting a syringe driver, but prescribing should be considered on an individual patient basis (eg with consideration of egfr, any regular medication that the patient is already on for symptom control etc). For more information please use the West Midlands Palliative Care Physicians guidance 3) Remember to consider compatability of drugs in a syringe driver, and also check which diluent is needed. Diluent will need to be prescribed. INDICATION MEDICATION SUBCUTANEOUS STARTING DOSE OVER 24 HRS Pain Morphine Sulfate Alfentanil (First Line if egfr < 30) ½ of total dose of oral morphine/ 24 hrs or Total of subcutaneous PRN doses / 24 hrs. Please seek Specialist Palliative Care advice Nausea and Vomiting Levomepromazine Haloperidol (First line if egfr <30) 6.25mg/24 hrs (max 25mg) 1.5mg - 2.5mg/24 hrs (max 5mg) Agitation in the dying patient Midazolam 5mg/24 hrs (max 30mg) Respiratory secretions in the dying patient Glycopyrronium Bromide 0.6mg/24 hrs ( Max 1.2mg)

3 ADMINISTRATION OF SUBCUTANEOUS DRUGS VIA McKINLEY T34 SYRINGE PUMP AND AS REQUIRED PRN ANTICIPATORY MEDICATION GP Practice Name Any known drug allergies (sensitivities) : GP Practice Contact Details: Opioid Patch in Situ: Please Circle: YES/NO ( please specify if patch is to remain in-situ or be removed if commencing syringe driver) egfr checked: Please Circle: YES/NO Greater than 30 ml/min Less than 30 Please refer to medication guidance on reverse SECTION 1 AS REQUIRED PRN ANTICIPATORY MEDICATION Drug Dose (Range) Frequency Max 24hr Dose Inclusive of Syringe Pump Indication Name of Prescriber GMC / NMC Number Contact Number Signature Pain / Breathlessness Anxiety / Agitation Nausea / Vomiting Respiratory Tract Secretions PLEASE PRESCRIBE AS REQUIRED DRUGS FOR ALL PATIENTS Consider prescribing for: Pain, Nausea/Vomiting, Agitation, Secretions. Given by subcutaneous injection unless otherwise indicated. Please see quick reference guide for Anticipatory Prescribing on page 1-2. For specialist Palliative Care Advice call (in working ) or Call (Compton Care Out of Hours)

4 CONTINUOUS SUBCUTANEOUS INFUSION (SYRINGE PUMP) AUTHORISATION GP Practice and Contact Details Any Known Drug Allergies Opioid Patch Insitu? Please circle YES/NO egfr Checked? Please circle YES/NO : Drug (By continuous subcutaneous infusion) Dose Range (In words and figures) Max Dose in 24 Name GMC no. and Signature Use water for injection as diluent unless otherwise indicated. Up to 17ml (20ml syringe) 22ml (30 ml syringe) Those changing the dose administered (within the range prescribed) should follow guidelines, record the reason for change in the care plan and act within their competency

5 Drugs in Situ (inc dose) CME McKINLEY T34 SYRINGE PUMP SUBCUTANEOUS CHECKLIST FOR COMMUNITY USE (DD/MM/YYYY) Time ( 24 Hour Clock) Syringe Size; mls /Hour Set to correct syringe type/size Rate settings mls/hour Solution Clear? Site Satisfactory? Cannula Resited? Volume to be infused (mls) Battery % Light Flashing Keypad Locked Drug Stock List Updated Initials

6 Do not commence infusion if battery status is 40% or less. ARE THERE SUFFICIENT DRUGS FOR THE NEXT 48 HOURS Drug: Drug Sheet Administration Record PRN or via Syringe Driver One Drug Per Page and time Dose and Route Ampoules used New Stock Stock Balance Batch Number / Expiry Full Signature / Printed Name / Designation

7 ARE THERE SUFFICIENT DRUGS FOR THE NEXT 48 HOURS Drug: Drug Sheet Administration Record PRN or via Syringe Driver One Drug Per Page and time Dose and Route Ampoules used New Stock Stock Balance Batch Number / Expiry Full Signature / Printed Name / Designation

8 ARE THERE SUFFICIENT DRUGS FOR THE NEXT 48 HOURS Drug: Drug Sheet Administration Record PRN or via Syringe Driver One Drug Per Page and time Dose and Route Ampoules used New Stock Stock Balance Batch Number / Expiry Full Signature / Printed Name / Designation

9 ARE THERE SUFFICIENT DRUGS FOR THE NEXT 48 HOURS Drug: Drug Sheet Administration Record PRN or via Syringe Driver One Drug Per Page and time Dose and Route Ampoules used New Stock Stock Balance Batch Number / Expiry Full Signature / Printed Name / Designation

PAIN MANAGEMENT Patient established on oral morphine or opioid naive.

PAIN MANAGEMENT Patient established on oral morphine or opioid naive. Important; It is the responsibility of the prescriber to ensure that guidelines are followed when prescribing opioids. Every member