Anticipatory prescribing

  • The aim of anticipatory prescribing is to ensure that patients with advancing illness and uncontrolled symptoms have timely access to medications to improve their physical comfort. Guidance for this is available in the Scottish Palliative Care Guidelines. The following guidelines are for use when usual measures are not available and will be available on a temporary basis during the Scottish COVID-19 response.
  • Use oral medication or a syringe pump where this is possible as per usual guidance  - see Scottish palliative care guidelines.
  • Alternative syringe pump (e.g. Graseby) may be used during the COVID-19 response, however non-syringe driver alternatives may be preferable to using unfamiliar equipment. Please liaise with your local team regarding this.
  • The use of medicinal products off-label or unlicensed medication is widely accepted practice within palliative care. Where possible we would recommend using licensed products but many of the recommendations below are off-label use either due to route, dose or indication. Our recommendations are based on available evidence and reflect a consensus of opinion about good practice in the management of adult patients with life-limiting illness.
  • Depending on the setting, it may be more appropriate to administer regular injections (see below for starting dose/frequency) or use alternative routes such as buccal, transdermal, rectal or nasogastric (NG) administration.

 

Alternatives to syringe pumps - non injectable

  • In the event that syringe pumps are not available, consider if any of the following options would be appropriate for your patient when they are unable to swallow.
  • Some drugs can be used for more than one indication; try to minimise polypharmacy where possible.
  • If the patient has an eGFR <30ml/min morphine should be used with caution due to risk of toxicity. Oxycodone may be a reasonable alternative.
  • Some medicines are available as buccal preparations – moistening a dry mouth helps absorption. Some injectable preparations can be administered by the buccal or sublingual route.
  • Drugs given by the sublingual or buccal route can also be dispersed in water and administered down an NG tube where this is in place.