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.

Hospice at Home nurses

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: resources and guidance

  1. Community palliative care prescribing table: usual injectable and syringe pump medication for symptom control. (BPCC) 2015
  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. 
  3. Anticipatory Prescribing Guidance Notes 2014 A quick reference guide.
  4. 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)
  5. If you are a GP in BNSSG you can use the EMIS Anticipatory Drugs protocol to issue FP10s and create an EMIS version of the community palliative care drug chart. Information about this and some top tips can be found in the Anticipatory Drugs Chart Resources.
  6. Anticipatory Prescribing: full standard operating procedure and guideline (BNSSG) 2015

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 and North Bristol 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

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)