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Clinical Guidelines

Resources for Healthcare Professionals

Below you'll find links to a selection of locally developed guidelines, links to national guidelines and other resources relating to palliative care. We hope these will be a useful addition to any local policies and guidelines in place in your area.

Remember - 24-hour specialist palliative care advice is available by calling our 24 hour clinical advice line on 0117 915 9430.

New Anticipatory Prescribing guidelines and resources are now available below.

The following live webinars to launch the guidelines took place on 28 February 2023.

Webinar one (15 mins): This standalone webinar highlights the key changes, and what community clinicians should do now.

Webinar two (45 mins): You may choose to watch part two which follows straight on from webinar one, and will give more detailed guidance about prescribing, patient safety, and practical tips.

Nurses at the Inpatient Unit

01.

Local clinical guidelines

02.

Local services for end of life care

03.

Advance Care Planning, Resuscitation Decisions and ReSPECT Plus

04.

Other links

1. Local clinical guidelines

All these guidelines have had input from a number of local specialists in Palliative Medicine working in different settings, e.g. Bristol Palliative Care Consultants (BPCC). Some have had wider consultation and approval for use in a specific geographical area e.g. Bristol, North Somerset and South Gloucestershire (BNSSG). The source and (where applicable) geographical area is identified for each one.

Guidelines on the management of pain due to cancer in adults

Guidelines on the management of cancer pain in adults with life limiting illness (Bristol and Weston Palliative Care Collaborative) Includes advice on starting and changing opioids plus easy opioid conversion tables (Updated 2022)

BNSSG Community anticipatory prescribing for end of life symptoms: new resources and guidance

  1. The Community Palliative Care (CPC) Drug Chart, supporting EMIS protocol and all resources (numbered 2-7), have undergone a significant revision to implement new clinical guidelines and to improve patient safety. How to update the protocol (from 1 March 2023), key changes and top tips can be found on Anticipatory Drugs Chart Resources.
  2. Pharmacies providing Enhanced Service for the Availability of Specialist Medicines and the medication they hold can be found here which includes a range of common medications for palliative care 2023. 
  3. Community palliative care prescribing table: symptom control in last days of life for adults with adjustments for specific circumstances if clinically indicated. (BNSSG 2023)
  4. Succinct and comprehensive clinical guidance including all new changes: Anticipatory Prescribing (AP) of Just in Case (JiC) medication for symptom control in adult palliative care patients in last days of life: BNSSG quick reference guide 2023
  5. Sirona Policy for anticipatory prescribing of 'Just in Case' medication for symptom control in the last days of life in adult community palliative and end of life care patients. (BNSSG 2023)
  6. Guide to your just in case medication - patient leaflet (BNSSG 2023)
  7. For organisations using pre-printed card booklet charts the new version of the CPC drug chart (V.8) can be ordered now from bnssg.fasttrack@nhs.net
  8. Sirona Policy: Informal Carer Administration of Subcutaneous Injections in the Community for End of Life Care
    1. Full policy
    2. Clinicians quick reference guide
    3. Carer's introduction leaflet-prior considerations
    4. Clinicians pack checklists/forms for: suitability, consent and competencies
    5. Carer authorisation chart: prescriber to complete one of the following (standard anticipatory medications are prepopulated unless stated)
    5.a. Blank opioid and antiemetic for patient on opioid or with eGFR<30ml/min/1.73m2
    5.b. Blank anti emetic suitable for opioid naïve patient with normal renal function
    5.c. Blank chart suitable for complex patients where individualised prescribing is needed
    6. Choose one carer instruction leaflet (according to their preference) for how to administer SC injection
    6.a. Instructions for injection via a line
    6.b. Instructions for injection with a needle
    7. Carer information leaflet: When to give injections for symptom control at the end of life (essential advice for carer)

Subcutaneous Fentanyl and Alfentanil

Subcutaneous Fentanyl and Alfentanil in Palliative Care: Information for Primary Care (St Peter's Hospice)

Subcutaneous fluids in palliative care

Policy for the administration of subcutaneous fluids (Sirona)

Subcutaneous fluids - Information for patients (Sirona)

Steroids

Palliative Care Guidelines for the use of steroids in patients with cancer (St Peter's Hospice)

Parkinson's Disease

Framework for professionals supporting patients deteriorating with Parkinson's Disease (PD) (St Peter's Hospice, North Bristol NHS Trust, University Hospitals Bristol and Weston NHS Trust)

2. Local services for end of life care

3. Advance Care Planning, Resuscitation Decisions and ReSPECT Plus

ReSPECT

  • ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment.
  • It is about creating a personalised recommendation for someone's future clinical care in emergency situations where they are not able to make decisions or express their wishes.
  • It can be used to record decisions related to cardiopulmonary resuscitation.

ReSPECT Plus

  • ReSPECT plus is an electronic shared care plan developed for BNSSG patients on a newly procured platform provided by Black Pear.
  • It consists of a combined emergency care plan, based on the nationally endorsed ReSPECT process and an advance care plan.
  • It includes practicalities and preferences related to emergency care and end of life.
  • ReSPECT Plus will ensure that all relevant providers involved in the patient's care can view the latest version of the plan, update, and print a downloadable PDF BNSSG ReSPECT form.
  • More information for primary care is available on the ReSPECT Plus Shared Care Platform
  • National guidance about the ReSPECT process is applicable to ReSPECT Plus and can be found at ReSPECT-National Resuscitation Council
  • Patient information leaflet on ReSPECT and ReSPECT plus

CPR decisions

General ACP information

Advance decision to refuse treatment (ADRT)

ADRT forms provided with permission from 'Deciding Right and The Northern England Clinical Networks'

  1. Fillable form (to download and complete)
  2. Print form (for handwritten completion)

Lasting power of attorney (LPA)

4. Other links

Here we've collated a number of other links and resources that could be useful.