Contents

Hospital Palliative Care Service The "Team" We provide the following services Referral is appropriate when How the Palliative Care Team works Making a referral Palliative Care Guidelines Management of Persistent Pain in the Palliative Setting Mild to Moderate Pain Paracetamol Codeine Phosphate Tramadol Non Steroidal Anti-inflammatory Drugs (NSAIDs) Digesic and Paradex (Dextropropoxyphene + Paracetamol) Nefopam Hydrochloride (Acupan) Opioid Therapy for Severe Pain Anticipate and Warn Against Side Effects Morphine Morphine Elixir (normal release) Slow Release Morphine Sulphate Subcutaneous Morphine Subcutaneous Morphine Infusions IV Morphine Infusions Intraspinal Morphine (Epidural /Intrathecal) Other Opioids Oxycodone Fentanyl Methadone Rarely-used Opioids Prescribing of Opioids Referral to Other Services Co-Analgesics Corticosteroids NSAIDs Tricyclic Antidepressants Anticonvulsants Ketamine Benzodiazepines Antiarrhythmics local anaesthetic class Baclofen Neuroleptics Bisphosphonates Calcitonin Nausea and Vomiting First-line Antiemetics Metoclopramide Cyclizine Haloperidol Second-line Antiemetics Domperidone Methotrimeprazine (Levomepromazine) Dexamethasone Prochlorperazine Hyoscine (Scopoderm TTS) Lorazepam Ondansetron Constipation Laxatives Enemas Severe Constipation Intestinal Obstruction General Considerations Medical Management Dyspnoea Medical Management Non-pharmacological Treatments Cough Dry Cough Productive Cough Excessive Secretions Hiccoughs Dry Mouth Sweating Itch/ Pruritis Agitation Delirium Management Care of the Imminently Dying Symptom Management Excessive Airway Secretions (Death Rattle) Terminal Agitation Subcutaneous Administration of Medications Continuous infusions Subcutaneous Bolus Medications Guidelines for Referral to the Palliative Care Service What is Palliative Care? Referral to Specialist Palliative Care A Referral to SPC is Appropriate When Discharge from Specialist Palliative Care How the Palliative Care Team work Making a referral Instructions for Medical/Surgical teams Instructions for Oncology/Haematology teams Appendices Appendix A: Syringe Driver Compatibility Chart Appendix B: Sample Subcutaneous Syringe Pump Prescription Appendix C: Sample Controlled Drug Scripts Appendix D: Medical Checklist for Discharge of Patients on Subcutaneous Syringe Pump Appendix E: Medical Checklist for Patients Transfering to the Nurse Maude Hospice Appendix F: Nursing Responsibilities when Discharging Patients with Palliative Needs from the Hospital Appendix G: References and Resources Authors Health Professional Resources Drug Information Sheets Intraspinal Analgesia Medical Guidelines Nursing Fact Sheets AD Pumps - Instructions and Virtual Pumps Educational Resources Articles of Interest Presentations Website Resources 2009 Palliative Care Study Days Pre Reading Psycho-Social Study Day Presentations Psycho-Social Study Day Pre Reading Symptom Management Study Day Presentations Symptom Management Study Day Palliative Care Service Resources Patient Information Resources Support Care Funding Framework Reviews and Feedback Managing Unscheduled Updates to the documentation Managing Scheduled Reviews of the documentation