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 which describes a stepped process for swapping opioids and provides a calculator tool and a worked example of an oral opioid switch.

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

If the information is not available on the SPS website or the information resources listed, or if your clinical scenario is complex, we would suggest you seek further advice from our Medicines Advice service.

Other primary resources

In addition to our own resources, we particularly recommend the following resources. They are free to access unless otherwise indicated:

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.

Local palliative care services

For questions relating to the care of specific individuals, it can be helpful to contact the community palliative team, Macmillan nurse or Marie Cure nurse caring for the patient; these specialists often work closely with district nurses.

Clinical Knowledge Summaries

There are several Clinical Knowledge Summaries (CKS) topics relating to palliative care:

• 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

The guidelines are aimed at primary care health professionals. Each covers management and includes prescribing information for recommended medicines.

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. It comprises:

• 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

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)
• Quick Clinical Guides for key topics such as nausea and vomiting, and bowel management in paraplegia and tetraplegia
• Topic monographs such as general advice on 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.

Secondary resources

The following resources may also be helpful and are freely available (registration is required where indicated):

NHS Scotland Palliative Care Guidelines

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

• pain
• symptom control
• palliative emergencies
• end of life care
• medicine information – individual monographs, listed alphabetically
• 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 healthcare professionals access to various resources. Free registration is required for mobile-friendly access and access to tools. Of particular use are:

• PANG (Palliative Care Adult Network) clinical guidelines and notes
• Paediatric clinical guidelines
• Syringe driver drug compatibility tool – up to five drugs can be selected

There is a separate area for information relating to palliative care in Wales.

Palliative Drugs

Palliative Drugs allows registered users to search and contribute to a bulletin board. Advice is provided on steps to take before posting a message.

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

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