New medication list for GPs supporting people who wish to die at home

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New medication list for GPs supporting people who wish to die at home

General practitioners wishing to achieve optimum symptom control for terminally ill patients who choose to die at home can access a new medication list to assist their decision making.

The list of nine medications was developed by a panel of 12 experts, including GPs, pharmacists, nurse practitioners and palliative medicine specialists, under the direction of the Australian and New Zealand Society of Palliative Medicine (ANZSPM).

The medications are appropriate for dying patients who are unable to swallow, and targets symptoms including pain, dyspnoea, nausea and vomiting, agitation and delirium, and respiratory secretions. Medications were also chosen on the basis of cost, simplicity of use, ease of storage, safety and efficacy.

ANZSPM project director Professor Liz Reymond said increasing numbers of people are dying expected deaths and most people want to die at home.

“So if GPs are going to manage those people at home, they need to become familiar with medications most suitable for use in the terminal phase, to allow their patients and the person’s family to get the best outcome.”

Dr Reymond, who is a palliative medicine specialist with a GP background, said the list complements the ANZSPM-endorsed list of medications in terminal care for residential aged care, but differs slightly in order to address concerns typically held by non-paid carers in the home environment.

“There are other palliative care medication lists available in various guidelines but generally they include a wide range of medications that often aren’t suitable for the home environment because of their safety profiles. They can also be difficult to obtain through community pharmacies if you need them in a hurry.”

The list represents the latest addition to ANZSPM’s resources for GPs under the Federal Government funded initiative, Decision Assist, a program to support GPs and aged care workers to provide palliative care and advance care planning to older Australians.

Taree GP, Dr David Healey, was one of the five GPs on the expert panel. He hopes the new medication list will improve community pharmacists’ understanding of what medication to stock and encourage more GPs to care for terminally ill people who wish to die at home.

“I’m hoping the list will help to build more GPs’ confidence, so they understand palliative care is certainly within their ability,” he said.

The medications on the End of Life (Terminal) Symptom Management Medications for Older Australians Living in the Community are:

·         Clonazepam liquid* (oral drops) - 2.5mg/ml

·         Clonazepam injection* - 1mg/ml

·         Fentanyl citrate injection** - 100mcg/2ml

·         Haloperidol injection - 5mg/ml

·         Hydromorphone injection - 2mg/ml

·         Hyoscine butylbromide (Buscopan) injection*** - 20mg/ml

·         Metoclopramide injection - 10mg/2ml

·         Midazolam injection** - 5mg/ml

·         Morphine sulphate injection - 10mg/ml AND 30mg/ml

* Non-PBS unless for seizure control
** Not on the PBS
*** Non-PBS unless for colicky pain. Unrestricted via the Repatriation Schedule

For a PDF with the new medications click here.