A6. Care of the dying Flashcards
End of life care given is…
-Compassionate
-Tailored to the person’s needs, wishes and preferences
-Regular and effective communication
-Assessment of the persons condition whenever it changes with appropriate timely responses
-Led by a senior responsible doctor and lead responsible nurse with access to palliative care
specialists
-Delivered by HCP with high standards, skills, knowledge and experience
-communicating respectfully and involving them, and the people important to them, in
decisions and by maintaining their comfort and dignity
Describe end of life care
-care shifts from active treatment to symptom management
-decisions regarding what further
care is appropriate
-Patients are encouraged to have these conversations in advance
-Empathy and compassion
Pharmacist’s role in end of life care?
-Deprescribing/ medicine rationalisation
-Supply of anticipatory medicines
-Guidance and support on syringe driver compatibility
-Advice on dose conversion with route
changing
management of end of life care?
-the process of withdrawing drugs
to try to improve outcomes
-Work with the patient and their
loved ones
what are anticipatory medicines?
-enable prompt symptom relief at whatever time the patient develops
distressing symptoms
-Medicines supplied in advance of a patient needing them
-A plan is made based on current management and current requirements
-Whilst all care it tailored we can predict the most common symptoms that patients experience as they are ending their life
what routes of administration can we use?
-PO (oral)
-IV (intravenous)
-SC (subcutaneous)
-Topical (usually patches)
Describe PO administration
-Easy to administer, safe to give at home.
-Concerns as patient deteriorates that may not be absorbing medicines as well
Describe IV administration
Hospital setting (most hospices not set up for IV drugs)
Describe SC administration
Painless. Can be set up at home or in hospice. Can administer multiple drugs via one needle
Describe topical administration
-Provide long-acting control e.g pain
-Not as good if patients condition changes quickly
Describe management of pain
-oral morphine/ oxycodone
-s/c diamorphine, morphine. oxycodone
Describe management of restlessness/ agitation
-oral haloperidol or levomepromazine
-s/c midazolam
Describe management of secretions
-oral antimuscarinic e.g. hyoscine butylbromide,
glycopyrronium bromide
-s/c hyoscine butylbromide
Describe symptom management of nausea and vomiting
-oral antiemetics e.g. cyclizine, metoclopramide,
levomepromazine
-s/c levomepromazine
Describe symptom management of breathlessness
Use opioids as per pain management
opioid conversion and route change?
one note
places for care of end of life?
-hospice
-hospital
-home
