10.11 Haemonc
10.11 Oncology [PDF link]: Common cancers, carcinogens, and tumour markers. Genetic conditions predisposing to cancer: Li Fraumeni, BRCA, Von Hippel Lindau (VHL) disease, Lynch syndrome (hereditary non-polyposis colorectal cancer syndrome; HNPCC), familial adenomatous polyposis (FAP), Gardner syndrome. Palliative care / end of life (EoL): pain medications (including opioids and conversion), hiccups, agitation and confusion, secretions, nausea and vomiting.
External links
Palliative care prescribing (including opioid conversion doses): NICE guidelines
West Midlands Palliative Care website has good guidelines on medication prescribing in EoL care, taking into consideration different limitations (eg in patients with liver dysfunction). Link here.
Death verification
Patient identity confirmed by checking wristband
No heart sounds, breath sounds, respiratory efforts, central or peripheral pulse for 5 minutes
No pupillary response to light, no corneal reflex
No response to voice, supraorbital or nail bed pressure
No pacemaker/implant in situ / Pacemaker/implant in situ
Date and time of death:
Confirmed by name, GMC no, at location.
End of life (EoL) / palliative bundle prescribing
Differs according to each Trust – consult trust policy. See also West Mids Palliative Care website.
Example of a palliative bundle to be prescribed PRN:
Hyoscine butylbromide 20 mg subcut injection q2h PRN, max dose 120 mg over 24h – for secretions
Midazolam 2.5 mg subcut injection q2h PRN, max dose 30 mg over 24h – for agitation
Morphine sulfate 2.5 mg subcut injection q2h PRN, max dose 20 mg over 24h – for pain
Levomepromazine 2.5-6.25 mg q4h PRN – for nausea/vomiting
Syringe driver can also be prescribed for slow release of a combination of up to 3 medications.
Eg of bundle: hyoscine butyl bromide 80 mg + midazolam 10 mg + morphine sulfate 10 mg – mixed with water for injections, slowly released over 24h
NB: McKinley is a specific brand of the syringe driver used. Detailed instructions on setting it up here.
Very useful list of medications that can be prescribed in syringe driver here – especially if pt needs alternatives (eg liver failure, CKD, etc)
