Clinical Guidelines

Below you'll find links to a selection of locally developed guidelines, links to national guidelines and other resources relating to palliative care. We hope these will be a useful addition to any local policies and guidelines in place in your area.

Remember - 24-hour specialist palliative care advice is available by calling our 24 hour clinical advice line on 0117 915 9430.

BNSSG formulary for palliative care

• Updated 2025 with traffic light status: BNSSG formulary for palliative care 

Guidelines on the management of pain due to cancer in adults

• Guidelines on the management of cancer pain in adults with life limiting illness (Bristol and Weston Palliative Care Collaborative) Includes advice on starting and changing opioids plus easy opioid conversion tables (Updated 2022)

BNSSG Community anticipatory prescribing for end of life symptoms: resources and guidance

• The Community Palliative Care (CPC) Drug Chart, supporting EMIS protocol and all resources (numbered 2-7), were revised in 2023.
  • Safety tip: Prescribers from Hospice and Sirona can create a Community Palliative Care Drug Chart in their EMIS documents. However, a hospice clinician may still request a primary care prescriber to complete or update charts for their patients. For all prescribers it is important to check EMIS documents of other organisations for most recent chart before creating or updating a chart. 
  • Process for anticipatory prescribing in EMIS, including creating and updating charts
  • How to update the EMIS protocol and other tips can be in Anticipatory Drugs Chart Resources
  • For organisations using pre-printed card booklet charts the new version of the CPC drug chart (V.8) can be ordered from bnssg.fasttrack@nhs.net
    
    
• Pharmacies providing Enhanced Service for the Availability of Specialist Medicines and the medication they hold can be found here which includes a range of common medications for palliative care 2023. 
  
  
• Community palliative care prescribing table: symptom control in last days of life for adults with adjustments for specific circumstances if clinically indicated. (BNSSG 2023)
  
  
• Succinct clinical guidance can be found here: Anticipatory Prescribing (AP) of Just in Case (JiC) medication for symptom control in adult palliative care patients in last days of life: BNSSG quick reference guide 2023
  
  
• Sirona Policy for anticipatory prescribing of 'Just in Case' medication for symptom control in the last days of life in adult community palliative and end of life care patients. (BNSSG 2023)
  
  
• Guide to your just in case medication - patient leaflet (BNSSG 2023)
  
  
• These two webinars were created to launch the new resources in 2023, they still contain relevant useful information:
  Webinar one (15 mins): This standalone webinar highlights the essential prescribing with additional practicalities relevant to the 2023 launch.
  Webinar two (45 mins): Part two follows straight on from webinar one, and will give more detailed guidance about prescribing, patient safety, and practical tips.
  
  
• Sirona Policy: Informal Carer Administration of Subcutaneous Injections in the Community for End of Life Care
  1. Full policy
  2. Clinicians quick reference guide
  3. Carer's introduction leaflet-prior considerations
  4. Clinicians pack checklists/forms for: suitability, consent and competencies
  5. Carer authorisation chart: prescriber to complete one of the following (standard anticipatory medications are prepopulated unless stated)
  5.a. Blank opioid and antiemetic for patient on opioid or with eGFR<30ml/min/1.73m²
  5.b. Blank anti emetic suitable for opioid naïve patient with normal renal function
  5.c. Blank chart suitable for complex patients where individualised prescribing is needed
  6. Choose one carer instruction leaflet (according to their preference) for how to administer SC injection
  6.a. Instructions for injection via a line
  6.b. Instructions for injection with a needle
  7. Carer information leaflet: When to give injections for symptom control at the end of life (essential advice for carer)

Subcutaneous Fentanyl and Alfentanil

• Safety tip: When prescribing fentanyl or alfentanil in palliative care advice from a Hospice or Specialist Palliative Care professional is recommended.
  
  
• Safety tip: Alfentanil is available in two different concentrations which are both available in the Enhanced Service Pharmacies. Avoid having both concentrations of alfentanil in use for one patient.
  
  
• Additional guidance is available here: Subcutaneous Fentanyl and Alfentanil in Palliative Care: Information for Primary Care (St Peter's Hospice 2025)

Subcutaneous fluids in palliative care

• Policy for the administration of subcutaneous fluids (Sirona)
  
  
• Subcutaneous fluids - Information for patients (Sirona)

Steroids

• Palliative Care Guidelines for the use of steroids in patients with cancer (St Peter's Hospice 2022)

Parkinson's Disease

• Framework for professionals supporting patients deteriorating with Parkinson's Disease (PD) (St Peter's Hospice, North Bristol NHS Trust, University Hospitals Bristol and Weston NHS Trust)

• An overview of current EOLC services in BNSSG CCG can be found here: remedy pathway - end of life care
  
  
• Sirona single point of access

ReSPECT Plus

• ReSPECT plus is an electronic shared care plan developed for BNSSG patients on a newly procured platform provided by Black Pear.
  
  
• It consists of a combined emergency care plan, based on the nationally endorsed ReSPECT process and an advance care plan.
  
  
• It includes practicalities and preferences related to emergency care and end of life.
  
  
• ReSPECT Plus will ensure that all relevant providers involved in the patient's care can view the latest version of the plan, update, and print a downloadable PDF BNSSG ReSPECT form.
  
  
• More information for primary care is available on the ReSPECT Plus Shared Care Platform
  
  
• National guidance about the ReSPECT process is applicable to ReSPECT Plus and can be found at ReSPECT-National Resuscitation Council
  
  
• Patient information leaflet on ReSPECT and ReSPECT plus
  
  
• Easy read ReSPECT guide

CPR decisions

• National Resuscitation Council guidelines: Decisions relating to cardiopulmonary resuscitation (CPR)

General ACP information

• General ACP information for professionals
  
  
• ACP patient information leaflet
  
  
• Why plan ahead for end of life care? NHS

Advance decision to refuse treatment (ADRT)

• ADRT guide for professionals
  
  
• ADRT guide for patients

ADRT forms provided with permission from 'Deciding Right and The Northern England Clinical Networks'

• Fillable form (to download and complete)
  
  
• Print form (for handwritten completion)

Lasting power of attorney (LPA)

• Information for patients

Here we've collated a number of other links and resources that could be useful.

• Guidance: Treatment and care towards the end of life (General Medical Council)
  
  
• Palliative Care Adult Network Guidelines plus (includes advice on symptom management and syringe driver compatibility)
  
  
• End of Life Care Ambitions
  
  
• Dying Matters
  
  
• End of Life Care Information for Nursing Homes
  
  
• End of Life Care Information for Residential Care Homes