This guidance contains a range of resources for anticipatory prescribing to facilitate good symptom control at the end of life. It takes into account the extraordinary circumstances of the COVID pandemic by suggesting non-injectable options for certain groups of patients.
A decision aid flow diagram is available here. Prescribers need to be aware that there may be shortages of our usual injectable medications, consider providing only
5 doses of each drug for less complex patients. Consider anticipatory prescribing for any patient in their last
4 weeks of life. A new EMIS protocol will be distributed in late April to support the process. Secondary care have aligned their discharge medication to comply with this guidance. We will be updating this page as resources become available.
1. Non complex patients
Suitable for patients who are: opioid naïve who do not have severe symptoms and who are not already on a range of medicines for symptom control.
Choose one option:
A: Non injection pack: If a carer can administer medications: (adjust morphine dose if eGFR <30 or if very frail).
Carer leaflet available here. These can be authorised for DNs to administer on the usual Community Palliaitve Care Drug Chart if needed.
B: Injection pack: If no carer to administer medications (adjust opioid according to eGFR)
Process: Either Prescribe on FP10, send to local or designated pharmacy and authorise on Community Palliative Care Drug Chart or use process for Just in Case Packs coming soon.
Suitable for those with complex severe symptoms, OR already on opioids OR history of complex symptoms e.g. medication for more than one symptom, OR can’t tolerate standard medication OR symptoms not controlled on Pack A.
Choose one option:
Other resources for anticipatory prescribing and symptom control