Palliative care: useful resources to support clinical decisions

SPS resources

SPS has a variety of resources on palliative and end of life care which we recommend you check first.

These include guidance on switching between oral morphine and other oral opioids in adult palliative care (SPS page) which describes a stepped process for swapping opioids and provides a calculator tool (SPS page) and worked example of an oral opioid switch (SPS page).

For advice on choice and administration of medicines for patients with impaired swallow, see our swallowing difficulties (SPS page) pages.

Other resources

In addition to our own resources, we recommend the following resources. They are free to access unless otherwise indicated. Resources are listed in the order you might prefer to use them.

Local formulary or guidelines

Your local Area Prescribing Committee, Medicines Management Group or similar body may have relevant guidelines or documents. For example, locally-approved guidance for symptom management or supply of anticipatory medicines for end-of-life care.

In secondary care, consult Trust guidelines.

Local palliative care services

For questions relating to the care of a specific individual, it can be helpful to contact the professional providing that care. This may be the community palliative team, a Macmillan nurse or a Marie Cure nurse; these specialists often work closely with district nurses.

In secondary care, contact the specialist palliative care team.

Different services may use different size syringes for Continuous Subcutaneous Infusions (CSCI, syringe drivers). For calculations, it is important to know what size syringe is being used.

NICE Clinical Knowledge Summaries

Clinical Knowledge Summaries (CKS) provide advice on palliative care for primary care practitioners. Topics cover management of people from 16 years and include:

• Palliative care – general issues
• Palliative care – constipation
• Palliative care – cough
• Palliative care – dyspnoea
• Palliative care – malignant skin ulcer
• Palliative care – nausea and vomiting
• Palliative care – oral care
• Palliative care – pain
• Palliative care – secretions

NICE Guidelines

Relevant NICE guidelines include:

• Palliative care in adults: strong opioids for pain relief
• Care of dying adults in the last days of life

British National Formulary

Guidance on prescribing in palliative care in the British National Formulary (BNF) and BNF for Children (BNFC) includes advice on:

• pain management, including equivalent doses of opioid analgesics
• symptom control, such as dry mouth, dyspnoea, hiccup, nausea and vomiting
• continuous subcutaneous infusions, including compatibility with diamorphine

BNFC guidance includes a link to the Association for Paediatric Palliative Medicine (APPM) master formulary.

APPM master formulary

The APPM master formulary provides guidance on medicines use in paediatric palliative care. The formulary is a 276-page pdf document that can be downloaded or viewed online.

Information is presented as:

• drug monographs, which include dosage information and key practice points
• appendices, such as morphine equivalent doses, subcutaneous infusion drug compatibility and switching from gabapentin to pregabalin in children with neuropathic pain

Marie Curie Knowledge Zone

The Marie Cure Palliative Care Knowledge Zone is suitable for health and social care professionals, including those who are not specialists in primary care. It covers condition-specific care, care at the end of life and symptom management. Scroll through the site to find the information you need.

NHS Scotland Palliative Care Guidelines

The Scottish Palliative Care Guidelines for adults are freely available. They contain sections on:

• pain
• symptom management
• palliative emergencies
• medicine information – individual drug monographs, listed alphabetically
• anticipatory prescribing
• syringe pump or driver guidelines
• last days of life
• out of hours handover
• health and social care resources
• patient information – printable leaflets for specific medicines

End of life guidance for diabetes care

End of life guidance for diabetes care, endorsed by Diabetes UK, provides useful advice on managing diabetes in the last year, month and days of life.

Palliative Care Matters

Palliative Care Matters provides access to two clinical tools for healthcare professionals involved in palliative and end-of-life care:

• Syringe driver drug compatibility tool – up to 5 drugs can be selected
• Opioid dose calculator tool

Other materials on the site are not being maintained or updated.

Palliative Care Formulary

The Palliative Care Formulary (PCF) is available to subscribers via Medicines Complete and provides guidance on medicines use in adult palliative care. It comprises:

• drug monographs (grouped into drug classes or therapeutic areas) that include pharmacology and pharmacokinetics, cautions, drug interactions and undesirable effects as well as dose and use in palliative care
• routes of administration monographs (one on transdermal patches includes advice on cutting patches, wearing patches during MRI and exposure to heat)
• general topics such as general principles for prescribing in palliative care and anticipatory prescribing in the community

Subscription to PCF also provides access to the Drug Compatibility Checker to check compatibility of medicines in a syringe driver.

The PCF Discussion Board provides a forum for palliative are professionals. Free registration is required to contribute and search previous posts. Advice is provided on how to navigate the forum and prepare a post.

Further advice

If the information is not available from the resources listed, or if your case is complex, our Medicines Advice service (SPS page) may be able to help. This service is available for healthcare professionals working in NHS primary care (including community pharmacy) in England.

In secondary care, you may be able to seek advice from your Trust Medicines Information service or directorate pharmacist.

Training resources

If you would like more information on how to approach answering questions on palliative care, we recommend:

Medicines Learning Portal

The Medicines Learning Portal is aimed at trainee hospital pharmacists but the content is also relevant to clinical primary care healthcare professionals. The portal includes a tutorial on palliative care which provides advice on:

• questions to ask when considering questions relating to palliative care
• the WHO pain ladder
• opioids for pain
• nausea and vomiting
• other symptoms
• syringe drivers

eLearning for healthcare

The Health Education England elearning for healthcare (elfh) hub has a programme (written in partnership with the Association for Palliative Medicine) supporting training in end-of-life care for all (e-ELCA). It offers 180 sessions which are grouped into 9 modules. Sessions are aimed at different staff groups and roles, including non-clinical staff and volunteers. Training for pharmacy professionals comes under ‘Allied health professionals’.

NHS staff can Register for an NHS England OpenAthens account and may be able to access via their personal ESR (electronic staff record) if they have one.

Centre for Pharmacy Postgraduate Education

CPPE provides learning materials on palliative care for pharmacists, pharmacy technicians and trainee pharmacists.

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