A Multidisciplinary Group was set up with representation from Consultants in Palliative Care from the CCGs, Bridgewater, Warrington and Halton NHS Trust and local Hospices, Medicines Management at the CCG and from Bridgewater and Macmillan representation from both Warrington and Halton.
This group produced a new End of Life Algorithm (which included updated information from the new edition of the Palliative Care Formulary [PCF7]) and Authorisation to Administer sheets to be used across Warrington and Halton.
Since the introduction of the new authorisation sheet we haven't had any incidents when above the maximum dose of a medication has been given, as the 24 hour dose in the syringe pump is on the same sheet as the 'when required' medication and also there is a column for prescribers to write the maximum dose allowed in 24 hours.
Qualitatively, district nurses have found the clearer advice useful to aid in titrating doses in the syringe pump and Palliative Care Teams are more confident that the dose in the syringe pump will not be increased too rapidly as the guideline contains clear information that doses of opiates use for incident pain e.g. dressing/catheter changes etc should not be included in this calculation.
