Formulary


	NHS Bath and North East Somerset, Swindon and Wiltshire CCG Royal United Hospitals Bath NHS Foundation Trust Great Western Hospitals NHS Foundation Trust Salisbury NHS Foundation Trust

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Formulary Chapter 21: Palliative Care Formulary - Full Chapter

Notes:

APRIL 2020 BSW End of life COVID palliative care guidance EOL COVID prescription support v5 Note this contains options that may be suitable to use in EoL patients with swallowing difficulties and where syringe drivers may be unavailable.

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

The Wessex Palliative Care handbook contains guidance to help GPs, community nurses and hospital staff as well as specialist palliative care teams. It aims to provide a checklist for the management of common problems in palliative care, with some information on drug treatment. It is not a comprehensive textbook. The Palliative Care Handbook: A Good Practice Guide Wessex Palliative Physicians Ninth Edition 2019

RUH - Palliative Care Guidance for GPs

For contact details of hospices and emergency drug lists and participating pharmacies across BSW, scroll to end of chapter or click here Community Pharmacy Emergency Drugs List & Contact Details

Details...

21.03

Just In Case Prescribing Primary Care

Just in Case Bags / Box formalise anticipatory prescribing at the end of life, and can minimise distress to the patient and their family, should there be a sudden deterioration when medications are not easily accessible.

The prescriber should ensure that all relevant agencies are informed that the Just in Case Bag / Box is within the care setting. The patient must be reviewed within 24 hours of medication being administered from the bag. The Just in Case Bag / Box prescription should be reviewed every 4 weeks

Morphine (Injections 10mg /ml)

Formulary

Community Just In Case Boxes
For pain
Use first line

Cyclizine
(Injection 50mg/ml)

Formulary

Community Just In Case Boxes
For nausea and vomiting

Diamorphine (Injections 10mg /ml)

Formulary

Current supply issues - use Morphine first line
Community Just In Case Boxes
For pain

Haloperidol
(Injection 5mg/ml )

Formulary

Community Just In Case Boxes
For hallucinations and agitation

Hyoscine Butylbromide
(Injection 20mg/ml )

Formulary

Community Just In Case Boxes
For respiratory tract secretions
For colic/reduce secretions in inoperable bowel obstruction

Hyoscine Hydrobromide
(Injection 400mcg/ml)

Formulary

Community Just In Case Boxes
For respiratory tract secretions

Levomepromazine
(Injection 25mg/ml)

Formulary

Community Just In Case Boxes
For nausea and vomiting

Midazolam
(Injection 10mg/2ml )

Formulary

Community Just In Case Boxes
For restlessness, anxiety and agitation

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Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to SPCs
	Scottish Medicines Consortium

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG
	High Cost Drug Approval System

Traffic Light Status Information

Status	Description
	RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.
	Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.
	Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.
	These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.
	Suitable for patient to be directed to buy themselves
	Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.
	(In use from Oct 2020) Used where a decision has been made by the BSW APC not to routinely commission this preparation for its licensed indications. Do not prescribe.
	Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.