Resources for GPs and professionals
Resources and guides for healthcare professionals
Advice and support
If you need advice or support please call us on 02087684582
Your call and brief details will be taken by a member of our admin team and forwarded to the appropriate team. A member of the team will ring you back on the same day. Please leave a number that we can easily contact you on.
Prescribing
Anticipatory prescribing refers to charts and, where appropriate, medications that are left in a person’s usual place of residence for use by visiting clinicians should problems arise with uncontrolled symptoms.
- Patients are most vulnerable to these in the last days of life and when they are no longer able to swallow
- The common ones are pain, nausea and vomiting, distress and agitation and respiratory secretions
- The guidance below covers these.
There has been controversy over the best practice for clinicians to adopt following the widely publicised Gosport Enquiry.
- General, national guidance and policies are currently under development and several members of the clinical team at St Christopher’s are closely involved with this work
- Our current guidance reflects the developing thinking, is subject to regular review and scrutiny and will be modified as further evidence emerges around the best and safest practice to adopt
- Our 24 hour specialist advice and support is there to back up this general guidance to ensure, as far as possible, that clinical decisions are individualised and safe.
Downloads
Anticipatory Prescribing Guidance for Frail Elderly Patients (PDF) Anticipatory Prescribing Guidance for Adults (PDF) Pan London Symptom Control Medication Authorisation and Administration Record (MAAR) (PDF)Guidelines
When a patient is nearing the end of their life, health care professionals should be aware of those who have internal cardiac defibrillators and should be considering deactivation in a timely manner to prevent inappropriate shocks at the end of someone’s life, which are painful and distressing for the individual and those close to them.
Palliative care can help with starting these conversations and coordinating the process. If someone is too unwell to attend the hospital for formal deactivation we have magnets available to take out for those who are dying and have an active device.
If you have a patient with an active internal defibrillator ( either an ICD or a CRT-D) in situ and you are concerned they are approaching end of life- please consider referring to palliative care for support with conversations around deactivation. If the patient has a Bromley or Croydon GP please consider referral to the Palliative heart failure service at St Christopher’s. Please see the guidance that we follow and if you have questions or are unsure whether to refer someone please call the hospice for advice.
Guidelines for deactivating implantable cardioverter defibrillators (ICDs) in people nearing the end of their life
From St Christopher’s Hospice
Guidelines On The Management Of Delirium In Palliative Care Settings (PDF)
This website hosts the PANG Palliative Care Guidelines developed by a collaboration of UK Health organisations. Additional material is provided by Dr Ian Back.
GPs in Bromley can refer into the monthly palliative heart failure MDM if they’re uncertain about a patient’s diagnosis and whether there is a need for sub cut furosemide to help direct correct treatment.
Email kch-tr.br-bromelyintegratedheartfailurenurses@nhs.net and the referral will get processed by the MDT co-ordinator for discussion.
