16.17 End of life symptom control for patients dying of COVID-19 infection

National Guidance

The following guidance has been issued for end of life symptom control for when a patient is dying of infection with COVID-19:

  • NICE COVID-19 rapid guideline: managing COVID-19 (NG191) – Palliative care section can be found here.
  • The Royal College of General Practitioners and the Association for Palliative Medicine: Community Palliative, End of Life and Bereavement Care in the COVID-19 pandemic can be found here.

These organisations will be updating their guidance as knowledge and experience develops. Please always check that you are referring to the current version.

Prescribing for end of life symptom control

Local prescribing guidance and a medication administration record (PMAR) have been developed to support patients with COVID-19 infection who require end of life symptom control. Prescribers are asked to prescribe for current, or emerging symptoms rather than in an anticipatory manner. This differs to existing processes for managing patients without COVID-19 infection which are being maintained.

For patients without COVID-19 infection, follow the existing process for Just In Case bags.

If you encounter any difficulties with medicines recommended in the COVID-19 guidance being out of stock, please contact the ICB's Medicines Optimisation team at d-icb.medicinesoptimisation@nhs.net. This will enable proactive updating of the guidance as appropriate.

Prescribing information for symptom management via syringe driver

Local concise prescribing guidance has been produced to support practitioners in the care of patients in the community who require medicines for symptom management of COVID-19 via syringe drivers as they approach the end of life. Please see here

The guidance draws upon national guidance to provide specific information for primary care on the use of end of life drugs administered via a syringe driver in the doses and combinations commonly anticipated to be used. It has had input from palliative care specialists, and support from One Devon ICB medicines optimisation and clinical effectiveness teams.

End of life care resource for GPs

A resource page for GPs providing guidance for end of life care of patients with COVID-19 is available which includes symptom management and links to the current formulary section. Other topics covered include: the conversation, treatment escalation plans/do not resuscitate orders, care at the time of death, bereavement advice and support, care for carers, and care for yourself. Please see here for the resource page for GPs.

Supply of medication for palliative care

The principal route of supply is through FP10 prescribing, for supply by a community pharmacy or dispensing practice. NHS England South West has renewed their Pharmacy Specialist Medicines Enhanced Service in which 21 community pharmacies across Devon are commissioned to maintain a minimum level of stock of more specialised medicines, including injectable medicines most likely to be used within the management of COVID-19. The pharmacies providing the service and the list of medications held by these pharmacies is available here (see under Guidance Resources).

Last updated: 19-05-2020


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