Summary of COVID-19 medicines guidance: Palliative and End of Life Care

Tiffany Barrett, Interim co-director, South West Medicines Information and Training, NHS England SouthPublished

This page summarises and signposts to medicine related guidance we’re aware of from professional and government bodies relating to coronavirus and palliative and end of life care.

Our advice is constantly reviewed as the pandemic situation evolves.

Whilst we have tried to ensure that the information on this page is complete, please report a concern if you feel anything is omitted or inaccurate. 

Advice in this area includes:

NHS England/NHS Improvement. Novel Coronavirus (COVID-19) standard operating procedure. Running a medicines re-use scheme in a care home or hospice setting v1

Last updated 2/9/2020

Our summary

This medicines re-use SOP for care homes and hospices is a time-limited SOP and would apply only during this period of emergency. The SOP –

  • Provides criteria for assessing medicines against and the conditions in which this might be acceptable.
  • Applies to medicines that have been supplied to patients while in a care home or hospice, have not been removed from that setting (other than for short periods of up to 24 hours) and have been stored in accordance with good practice guidance on storing medicines in a managed setting.
  • Applies to all medicines including liquid medicines, injections (analgesics, insulin), creams and inhalers that are in sealed or blister packs, when appropriate criteria are met.

NHS England/NHS Improvement: Management of palliative care in hospital

Last updated November 2020 (update of version 2 to ensure hyperlinks work)

Our summary:

  • Symptom management – short summary [p3]
  • Symptom management – pharmacological and non-pharmacological approaches appendix 1 covering breathlessness [p6], cough [p7], delirium [p8] and fever [p9]

NICE guideline [NG163]: COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community.

Last updated 13/10/2020

Our summary:

This guideline covers a number of areas including

  • Managing symptoms (including cough, fever, breathlessness, anxiety, delirium and agitation) [sections 3-7]
  • Managing medicines for patients with COVID-19 [section 8]
  • Prescribing anticipatory medicines for patients with COVID-19 [section 9]

The guideline links to other relevant NICE guidelines.

RCGPLearning End of Life Care resources Updated 12/1/21

Our summary

  • The RCGP has produced a number of resources to support end of life care.
  • They also link to some key external resources including a document entitled “Clinical guide for the management of palliative care during the coronavirus pandemic: Symptom management using non-oral and non-parenteral routes for administration of medication” (click on external resources and then scroll down the list to find the document)

Royal Pharmaceutical Society Emergency Supply of Controlled drugs: supply during a pandemic 

Published 6/5/2020 (log-in required to access)

Our summary

  • The RPS summarises the legislative changes that have been made around controlled drugs and the situations in which those changes might be enacted
  • The changes introduce emergency measures which allow registered pharmacies to supply Schedule 2, 3 or Schedule 4 part 1 CDs without a prescription where the individual has been receiving them as part of on-going treatment and where regular access to a regular repeat prescription is not possible
  • These changes, whilst enabled, will only be actionned if and when the Secretary of State switches on the measure

Royal Pharmaceutical Society Changing the intervals of instalments for controlled drugs during a pandemic

Published 6/5/2020 (log-in required to access)

Our summary

  • The RPS summarises the changes to controlled drug legislation which allow pharmacists to change the intervals of instalments without a new prescription following agreement with the prescriber or their appointed representative
  • These are contingency changes which can only be activated by an announcement by the Secretary of State
  • This document describes circumstances where a pharmacist might vary instalment timings and amount if these changes are activated

Care Quality Commission: End of Life Care Planning and medicines optimisation

Last updated 9/2/2021

Our summary

  • CQC summarises the key principles of ensuring medicines are used appropriately and effectively in the management of end of life care

Association for Palliative Medicine of Great Britain and Ireland: Guidance on Covid-19 and palliative EOL and bereavement care in secondary care

Our summary:

The APM website provides links to:

British Geriatrics Society End of Life Care in Frailty

Our summary

The aim of this guidance is to support clinicians and others in considering the needs of and providing high quality care for frail older people as they move towards the end of their lives. The BGS guidance is divided into 24 chapters including –

  • End of life care in frailty – pain
  • End of life care in frailty – medicines management
  • End of life care in frailty – dysphagia
  • End of life care in frailty – care homes
  • End of life care in frailty – community settings Collated list of resources for COVID-19 in palliative care

Last updated 26/1/2021 version 14

Our summary:

This regularly updated, collated list of resources for COVID-19 in palliative care contains links to key resources including:

  • COVID-19 and Palliative End of Life and Bereavement care in secondary care (Northern Care Alliance NHS Group and Association for Palliative Medicine) [p1]
  • COVID-19 local guidelines [p2]
  • useful resources such as guidelines for carer administration of subcutaneous medicines [p2]

Royal College of General Practitioners and the Association for Palliative Medicine Community Palliative, End of Life and Bereavement Care in the COVID-19 pandemic

Last updated March 2020 Version 3

Our summary

The link takes you to the RCGP learning page where you’ll find a link to the most recent version of the Community Palliative, End of Life and Bereavement Care in the COVID-19 pandemic guidance. This guidance covers topics including –

  • Symptom control related to infection with COVID-19
  • Flowcharts to assist with fever, pain, cough, breathlessness, delirium
  • Holistic care – psychosocial, spiritual, religious and cultural beliefs of patients and families

The Palliative Care Formulary

Our summary

  • The Palliative Care formulary is accessible on Medicines Complete through a free Open Athens account. Instructions for how to register for this and access the PCF can be found here.

Administration update (18/2/2021)