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 nurse with a patient

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 pain due to cancer in adults (BPCC). Includes advice on starting and changing opioids plus easy opioid conversion tables. (Updated 2017)

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. Informal carer administration of subcutaneous injectable medication
  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)

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)