Symptom Control Packs
Packs for symptom control at the end of life have been brought together by palliative care teams
and RCHT Pharmacy, and are in keeping with national guidance from the APM (Association of Palliative Medicine).
Aims of pack provision
-To support the GPs / clinicians in providing compassionate and timely care to COVID-19 patients in their homes
-These packs are to be used following a clinical assessment of the patient by the GP and supplied to patients that are actively dying, not ‘just in case’
To negotiate CD regulations and potential safety issues they are not "just in case" but for people who are symptomatically at end of life for clinicians to take in with them and leave. Patients and carers will be talked through what for and what not ...and will contain an aide memoir of the reason each med in Pack. Carers will also need to know about safe disposal of partially used or un-used packs.
For many reasons RCHT would like to issue centrally and will keep on a shelf 50 or so that they can be ordered with 24 hr turn around further stock.
They will need to be stored in a PCN as per CD rules and regs and distributed as PCN sees fit among it's practices.
They will need to be prescribed by clinician on an FP 10 - so those with systems that allow may want to make a template etc.
KCCG (Dr Rob White is leading with Paul Abrams at KCCG) needs the lead practice name for each PCN where such packs can be stored and distributed from, with courier network distribution and signed for with email to acknowledge receipt.
Initial roll out will be 10 packs per 10,000 PCN patients, but with ability to restock through RCHT pharmacy. Cost will be £32 per pack.
There will be information within the packs for carers about administration, which should support your consultation briefing about symptom control.
They contain :-
Lorazepam 1mg tab S/L 1hrly/prn (max 4mg daily) for shortness of breath or agitation (supply – 14 tablets)
Levomepromazine 6mg tablet 2 hrly/prn for nausea (max 24mg daily) , vomiting or agitation (supply 12 tablets)
Hyoscine hydrobromide 1.5mg patch – 1 patch every 72 hours to decrease lung secretions (supply 1 patch)
Fentanyl patch 12.5mcg- 1 patch
Paracetamol 500mg Tabs x20 prn
Oramorph 10mg/5ml 25ml- 2.5mg prn