Important Changes in Cumbria Palliative Care Prescribing Practice

Cumbria is changing practice, from 1st April 2011.

The Area Prescribing Committee has recommended the following changes:

  • All strong opioids are to be prescribed by brand name
  • “Just in Case” prescribing is to be encouraged and promoted
  • Morphine is to replace diamorphine as the subcutaneous injectable strong opioid of choice for palliative care patients in Cumbria

Brand name prescribing:
For modified release morphine, the APC recommends “Zomorph” For simple guidance on morphine prescribing for health care professionals click here
For a patient information leaflet click here

For fentanyl transdermal patches the APC recommends “Matrifen” For simple guidance on fentanyl at the end of life click here

Just in Case prescribing:
Anticipatory prescribing is good practice in palliative care.

Having injectable medication easily available in the home “just in case” of a sudden deterioration may prevent an unnecessary admission, or family members struggling to get a prescription dispensed during a stressful phase of their loved ones illness.
For the Cumbria “Just in Case” prescription sheet click here.

Morphine to replace diamorphine
From 31.3.2011, morphine is recommended as the injectable strong opioid of choice for palliative care patients across Cumbria. This also applies to out of hours service providers.
To convert from oral morphine to SC morphine DIVIDE BY TWO For simple guidance for healthcare professionals click here.

Diamorphine will only be used exceptionally, where high doses are required (>180mg morphine/24h SC).

THIS IS ALL PATIENTS ON > 180mg MR morphine 12 hourly or

  • 90mg MR oxycodone 12 hourly or
  • 200mcg fentanyl patch

To convert from oral morphine to SC diamorphine DIVIDE BY THREE

For approximate opioid equivalents click here.

THINK AHEAD

ANTICIPATE

GET SPECIALIST ADVICE