House Keeping Syringe Driver Training: McKinley T34 Pump Fire - PDF document

Palliative & End of Life Care Services N E Lincs House Keeping Syringe Driver Training: McKinley T34 Pump  Fire alarm and toilet facilities  Willingness to participate  Embrace a supportive and safe learning environment  Confidentiality - discussions stay in the room  Non personal  Listen and respect  Mobile phones  Keep to time  Evaluation Form Palliative & End of Life Care Services N E Lincs Palliative & End of Life Care Services N E Lincs 1 1 Palliative & End of Life Care Services N E Lincs 2 Professional Responsibility And Aims Of The Training Accountability  The registered nurses/practitioners' responsibility and The Code (NMC,2015) sets out the core standards of accountability. conduct and practice expected of nurses and midwives, it  Indications for use is a positive tool to use that reflects contemporary  Support of both patient and family nursing and midwifery practice and plays a key role in the  Common drugs used in the syringe driver for palliative and end of revalidation process life patients  Converting drugs from oral medication to the subcutaneous route  Pre-operational inspection of the machine • Prioritise people  Demonstration of safe and effective preparation and management • Practice effectively of the syringe driver • Preserve safety  Knowledge of the appropriate policy for Procedure for the use of • Promote professionalism and trust the McKinley Syringe Pump in Palliative and End of Life Care Be aware of other regulatory bodies Palliative & End of Life Care Services N E Lincs 3 Palliative & End of Life Care Services N E Lincs 4 Indications For Using The Preserve Safety Syringe Driver Unable to take oral medications  Swallowing problems 18. Advise on, prescribe, supply, dispense or  Uncontrolled nausea and/or vomiting  Intestinal obstruction administer medicines within the limits of your  Profound weakness in last days of life training and competence....  Malabsorption 19. Be aware of, and reduce as far as possible, Contra-indications  Pain which has not been controlled by oral analgesia any potential for harm associated with your  Special care to be taken with very restless patients practice…. Palliative & End of Life Care Services N E Lincs 5 Palliative & End of Life Care Services N E Lincs 6 12/06/2019 1

Palliative & End of Life Care Services N E Lincs Sites That Should Not Be Used For Subcutaneous Infusion Sites Cannula Placements Are: Anterior Anterior Aspect Chest Wall Of Upper Arm  Lymphoedematous limbs  Sites over a bony prominence Anterior Abdominal  Previously irradiated skin area Wall  Broken skin Anterior Aspect  Sites near a joint  Discuss with patient their preferred Of Thighs place to site infusion  Localised areas of disease  Visually inspect at each time patient  Affected limb following lymph node reviewed dissection Palliative & End of Life Care Services N E Lincs 7 Palliative & End of Life Care Services N E Lincs 8 Diamorphine Communication Indications for use: pain control & breathlessness Explain to the patient and relatives:  Caution in renal failure  Used because of its high solubility: 1g dissolves in 1.6mls of water  What a syringe driver is  No clinical advantage over Morphine  How it works  No maximum dose  No contra-indications if titrated carefully against  Why the team have chosen to use it a patient's pain  Allow time for questions  Onset of action 5-10 mins SC, duration of action 4hrs  Use water or 0.9% sodium chloride as diluent Palliative & End of Life Care Services N E Lincs 9 Palliative & End of Life Care Services N E Lincs 10 Converting Oral Morphine To Managing Diamorphine Shortage Subcutaneous Diamorphine  As an alternative, prescribe Morphine Sulphate  Add together oral analgesia (Not PRN doses) in injection (10/15/20/30mg/ml) milligrams/24 hours  Divide total dose by 3  Morphine Sulphate is compatible with the  This is the required 24 hour dose of Diamorphine via commonly used drugs in a syringe pump e.g. subcutaneous infusion Haloperidol, Levomepromazine, Hyoscine  Divide the total 24 hour dose of S/C Diamorphine by Butylbromide, Metoclopramide, Glycopyrronium and 6 to give the required dose of S/C breakthrough/prn Midazolam medication  Holistic assessment of patient  Seek specialist advice re conversions etc. Palliative & End of Life Care Services N E Lincs 11 Palliative & End of Life Care Services N E Lincs 12 12/06/2019 2

Palliative & End of Life Care Services N E Lincs Oxycodone Converting Oxycodone  Oral Oxycodone to SC Oxycodone divide by 2 Similar properties to Morphine, acts on different pain receptors.  20mgs Oral Oxycodone = 10mgs s/c Oxycodone Morphine is always the first drug of choice  Useful for patients who cannot tolerate  Oral Morphine to Oral Oxycodone divide by 2 Morphine. Appears to cause less sedation and vomiting than Morphine but more constipation.  20mgs oral morphine = 10mgs oral oxycodone  Used for patients with renal impairment  Diluent Water for injection or 0.9% Sodium  Note: injection solution is called Oxycodone Chloride Hydrochloride solution for injection or OxyNorm  Caution when mixing with subcutaneous injection Cyclizine Palliative & End of Life Care Services N E Lincs 13 Palliative & End of Life Care Services N E Lincs 14 PRNs Transdermal Fentanyl  Strong opioid licensed for severe chronic  Why given? (persistent, long-term) pain  Dose?  It is not licensed for uncontrolled or acute pain.  Effective?  Available in 12mcg, 25mcg, 50mcg, 75mcg and 100mcg in 72hrs  Duration?  Pain unrelieved by Morphine will not be  Pattern? relieved by Fentanyl  Steady-state plasma concentration generally  Acute events? achieved by 36-48hrs, but sometimes only  Over the counter? achieved after 9-12 days  Small percentage of patients require patch  Holistic assessment! change every 2 days (Always seek specialist advice in this situation) Palliative & End of Life Care Services N E Lincs 15 Palliative & End of Life Care Services N E Lincs 16 Transdermal Fentanyl Chart Transdermal Fentanyl 4 hourly oral Morphine (mg) Transdermal Fentanyl Patch 24 Hourly Oral Morphine (mg) Strength (mcg/hr) Indications for use <20 25 <135  Difficulty swallowing tablets/tablet 25 – 35 50 135 – 224 phobia/compliance 40 – 50 75 225 – 314  Intolerable effects with Morphine e.g. 55 – 65 100 315 – 404 nausea/vomiting/hallucinations/constipation 70 – 80 125 405 – 494  Renal impairment 85 – 95 150 495 – 584 100 – 110 175 585 – 674  High risk of tablet misuse 115 – 125 200 675 – 764 130 – 140 225 765 – 854 The Fentanyl patch should continue to be changed 145 – 155 250 855 – 944 as prescribed and will control the 160 – 170 275 945 - 1034 background/chronic pain 175 – 185 300 1035 - 1124 Palliative & End of Life Care Services N E Lincs 17 Palliative & End of Life Care Services N E Lincs 18 12/06/2019 3