Anticipatory Prescribing

  • Subcutaneous medication available in patient’s home in advance of any deterioration in the patient’s ability to take medication orally.
  • Allow nurse/GP to administer medication promptly for pain, restlessness and agitation, nausea and vomiting, respiratory tract secretions or breathlessness.
  • Assess risk of misuse.
  • Explain to patient/carer purpose and how to seek help if symptoms arise.
  • Remember to complete the District Nursing Authorisation sheet (DNS Forms) in addition to the FP10.

[icon name=icon-download-alt] Example FP10

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Anticipatory Prescribing
Assessment of current medication, the discontinuation of non-essential drugs and the Anticipatory Prescribing of as required sub-cutaneous medication for potential symptoms are integral components of care at this stage.

All medications, including anticipatory medicines, must be targeted at specific symptoms, have a clinical rationale for the starting dose, be regularly reviewed, and be adjusted as needed for effect.

The reason for any intervention, including the use of a syringe driver, must be explained to the dying person and to those important to them. If required, the use of the syringe drive should be explained before it is used and written information offered. The likely side effects of specific interventions, especially those that may make the person sleepy, must be discussed with the dying person to enable them to make informed decisions.

Health and care staff must ensure that medicines, equipment and other aids that can improve the dying person’s comfort and dignity are obtained as soon as they are needed, or in anticipation of needs.

It is crucial that providers of Out of Hours Care and the Ambulance Service are notified of the patient’s status at this time using the EPaCCS Template

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Nottingham City
[icon name=icon-download-alt] Anticipatory Supply of Palliative Care Medications for Adults Policy
[icon name=icon-download-alt] DNS1 AP (April 2017)
[icon name=icon-download-alt] DNS1 SP SUBCUTANEOUS SYRINGE PUMP PRESCRIPTION RECORD

Nottinghamshire County Health Partnerships
[icon name=icon-download-alt] Policy for the Anticipatory Supply of Palliative Care Medications
[icon name=icon-download-alt] ASS1

Bassetlaw
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