NHS FIFE / NHS SCOTLAND PALLIATIVE CARE GUIDELINES

As part of Living and Dying Well – Building on Progress National Palliative Care Guidance has been developed for use across Scotland. The guidelines have been developed in accordance with AGREE criteria and are supported by Healthcare Improvement Scotland and the Scottish Partnership for Palliative Care. The Scottish Palliative Care Guidelines reflect a consensus of opinion about good practice in the management of adult patients with life limiting illness. They are designed for healthcare professionals from any care setting who are involved in supporting people with a palliative life-limiting condition. Adherence to guideline recommendations will not ensure a successful outcome in every case. It is the responsibility of all professionals to exercise clinical judgement in the management of individual patients. Palliative care specialists occasionally use or recommend other drugs, doses or drug combinations.

The guidelines are available at: http://www.palliativecareguidelines.scot.nhs.uk/

There are specific prescribing points relating to cost effective prescribing within Fife that should be followed when considering using the guidance as below:

Fife Advice NHS Scotland Guidance MR Morphine Sulphate – preferred brand in NHS Pain Management Guidance Fife is Zomorph® MR Capsules – ensure patients Choosing and Changing Opioids in Palliative Care remain on the same brand Breathlessness Fentanyl patch should be prescribed as the Fentanyl Patches in Palliative Care preferred NHS Fife brand Matrifen® – ensure Choosing and Changing Opioids in Palliative Care patients remain on the same brand Bowel Obstruction Care in the Last Days of Life Oxycodone MR preferred brand in Fife is Oxypro® Pain Management Guidance and IR form preferred Fife brand is Shortec® – Oxycodone ensure patients remain on the same brand Choosing and Changing Opioids in Palliative Care Breathlessness The preferred breakthrough immediate release Choosing and Changing Opioids in Palliative Care fentanyl products in Fife are AbsOtral® and Pecfent® Fentanyl Nasal Spray and are restricted to specialist initiation / Fentanyl Sublingual (Abstral) recommendation in Fife Diamorphine is no longer 1st line s.c. choice (3rd Pain Management Guidance choice) and Morphine Sulphate should be used 1st Choosing and Changing Opioids in Palliative Care line subcutaneously and Oxycodone as 2nd line – Anticipatory Prescribing seek advice if patient intolerance or large breakthrough doses Alfentanil – unlicensed, sublingual / buccal spray not Alfentanil in Palliative Care used in NHS Fife Macrogol choice – the preferred NHS Fife brand is Bowel Obstruction Laxido® Constipation Pain Management Guidance Dihydrocodeine is not included in the Fife Formulary. Pain Management Guidance

Epistatus® is the preferred formulation of buccal Seizures midazolam in Fife. Seek specialist advice before Midazolam prescribing. Cyclizine should be used rather than haloperidol as Anticipatory Prescribing alternative antiemetic to Levomepromazine in anticipatory prescribing e.g. Just in Case Boxes

Author: David Binyon, Primary Care Development Pharmacist and Paul Wilson Palliative Care Pharmacist Version: 1 Date: May 2015 Approved by NHS Fife ADTC: June 2015 Useful Telephone Numbers Consultants in Palliative Medicine Dr Fran Stretton Victoria Hospice, 01592 648072 Dr Jo Bowden , Dunfermline 01383 623623 Dr Steinunn Boyce Victoria Hospice, Kirkcaldy 01592 648072 Dr K Steel Victoria Hospice, Kirkcaldy 01592 648072

Specialist Palliative Care Cedar House (Mon - Fri), Kirkcaldy 01592 648004 Nurses

Palliative Care Pharmacists Paul Wilson (Hospital) 01592 643355 (ext. 21544)

Niall Dewar (Primary Care) 01334 465949

The index to the full guidance can be accessed at: http://www.palliativecareguidelines.scot.nhs.uk

Individual guidance can be accessed by following the links below: Pain related guidance Symptom Control Medicines Information Pain Assessment Anorexia/Cachexia Alfentanil Pain Assessment - Cognitive Impairment Breathlessness Fentanyl Nasal Spray (Pecfent) Pain Management Guidance Bowel Obstruction Fentanyl Patches Neuropathic Pain Constipation Fentanyl Sublingual (Abstral) Choosing and Changing Opioids Cough Ketamine Anticipatory Prescribing Delirium Levomepromazine Depression Lidocaine Diarrhoea Methadone Palliative Care Emergencies Hiccups Methylnaltrexone Bleeding Mouth Care Midazolam Hypercalcaemia Nausea and Vomiting Naloxone Malignant spinal cord compression Pruritis Octreotide Seizures Sweating Oxycodone Superior Vena Cava Obstruction Weakness / Fatigue Phenobarbital (Phenobarbitone)

End Of Life Care Renal Disease in the Last Days of Life Syringe Pumps Out of Hours Handover Care in the Last Days of Life Subcutaneous Fluids Severe uncontrolled distress Rapid Transfer Home in the Last Days of Life

Documentation supporting the NHS Fife Just in Case process is available.

NHS Scotland also has further palliative care resources available through the Knowledge Network. This includes access to the most up to date edition of the Palliative Care Formulary which is available to individuals with an Athens username and password.

Author: David Binyon, Primary Care Development Pharmacist and Paul Wilson Palliative Care Pharmacist Version: 1 Date: May 2015 Approved by NHS Fife ADTC: June 2015