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16. Palliative Care Guidelines

First line drugs Second line drugs Specialist drugs Secondary care drugs
Recommended in both primary and secondary care Alternatives (often in specific conditions) in both primary and secondary care; Where a specialist input is needed (see introduction for definition) Prescribing principally within secondary care only

Please refer to the Palliative Care Handbook (developed by Plymouth Area, South Hams & West Devon and North & East Cornwall Specialist Palliative Care Teams) for further information.

Cautionary Note:
Some of the drug usages recommended are outside of product licence, either by way of indication, dose or route of administration. However, the approaches described are recognised as reasonable practice within palliative medicine in the UK. If you are concerned about prescribing in such areas, the Specialist Palliative Care Teams are available to provide further information and support.     
 
This formulary has been produced with reference to local symptom control guidelines. Each section lists drugs that have a recognised place in the control of individual symptoms.
The following overarching principles apply, and may form the basis of future audits:

  • Recognised effective drug treatments should be available to all patients. This may not include every drug in every situation and not all conceivable circumstances and possible beneficial therapies can be anticipated.
  • Safe drug administration is of paramount importance. For example, providing that there is evidence of compatibility, selected injections can be mixed in a syringe. However, care should be taken to avoid multiple combinations whenever possible, crystallisation should be watched for along with loss of clinical effect, and there should be an awareness of the higher probability of local skin irritation. (See section on Syringe drivers for further information)
  • Cost-effectiveness. This should be recognised as an issue. Attempts should be made to establish cheaper drugs before more expensive ones.

General Principles of Symptom Management

  • Aim to achieve best possible quality of life
  • Sensitive explanation and inclusion of patient and carers in decision making are essential      
  • Accurate and full assessment is essential for both diagnosis and treatment
  • When symptoms are difficult to control, there may be more than one cause, or there may be emotional, psychological, social or spiritual factors, hence the need for a multi-professional approach
  • Be careful that drug side effects do not become worse than the original problem
  • Frequent re-assessment is essential
  • Consider referral for a specialist palliative care opinion:

              if there is a problem which does not respond as expected

              in complex situations which may benefit from specialist expertise

              for support for the hospital or primary health care team

Last updated by: Carol Webb on 14-06-2012 10:48