2.3 Managing medications
The following information describes the medications commonly used in palliative care to relieve discomfort and pain. It includes notes on using medications safely, using a syringe driver and giving injections.
Using medications safely
Most medications for managing symptoms need a prescription from the doctor and are bought from a pharmacy. An information leaflet is usually supplied with medication. Read this leaflet as it contains information about the medication, its use and side effects.
All medications are labelled with instructions. Make sure you follow these instructions. The person you are caring for should:
- Take the dose as directed at the times indicated
- Never take more than the recommended dose
- Complete the whole course of medication as per instructions even if they feel better
Seek advice from the doctor, PCSE nurse or pharmacist if there are side effects and/or difficulty taking medication.
Apply for a PBS Safety Net Card
Keep a record of the PBS medicines you buy on a Prescription Record Form (available from pharmacists). If you always use the same pharmacist, you can ask them to keep a computer record instead. Once the threshold is reached, your pharmacist will give you a Safety Net card. Your PBS medicines are then cheaper or free for the rest of that calendar year. To find out more, call 1800 020 613 or go to www.pbs.gov.au.
Go to the same pharmacy to get prescriptions when possible. Order repeat prescriptions BEFORE the medication runs out – allow at least 2 days.
- Keep medications in a safe place away from children: a cool dry cupboard is a good place. Generally, medication should be stored in the original container
- Some medications should be kept in a fridge – check the label
PCSE team do not carry medications with them. Staff will help you to make sure you have enough medications available in the home.
Good practice with medications
- Never take another person’s medications
- Return out of date (expired) or unused medications to the pharmacy for safe disposal
Always tell the doctor and the PCSE team about any other medications used e.g. herbal medications or over the counter medications
Keep track of medications
Use a medication chart to keep an up to date list of the medications being used, and have it available when seeing a health professional or pharmacist.
Ask the PCSE team about using a Medicines Chart. We can give you a template or you can download an app for your phone.
Palliative medications may be needed to treat or prevent symptoms such as pain, nausea and vomiting, anxiety, shortness of breath and others. Some treatments work to control or slow down progress of a disease rather than curing it. These include chemotherapy, hormone treatments and radiotherapy. Their key benefit is to improve the quality of life.
What is different about palliative medications?
Standard medications may be used differently for palliative care. For example, using antipsychotic medications to treat nausea, anticonvulsants to treat pain, and opioids to treat breathing difficulties. Ask your doctor, the PCSE team or pharmacist if you have any questions.
Note: Sometimes it may be difficult to get some medications and some are more expensive if they are not subsidised by the Pharmaceutical Benefits Scheme (PBS). Ask us if you have any problems.
If someone is unable to swallow, there are various other ways to administer medications. If tablets can’t be swallowed, options include: syrup form or crush or dissolve medication or give medication by injection
Reviewing unnecessary medications
If someone is living with multiple medical conditions, they are likely using multiple medications. The PCSE team will review all medications, based on assessment of risks, interactions, costs, and prognosis.
Emergency medications are ‘ready-to-go’ injectable medications provided to be kept in the home. They are used if symptoms get worse or new symptoms arise or ability to swallow or absorb medications by mouth decreases. Emergency medications are prescribed for pain, nausea, vomiting, breathlessness or breathing problems, anxiety and restlessness. The medications are provided ‘ready-to-go’ to ensure you can keep caring in the home and as a form of ‘insurance’, in case the need ever arises. The nurses administer them, and carers can be taught to use them also.
Make sure you have enough emergency medications on hand. The PCSE team do not carry medications and they can only give the emergency medications that are already prescribed and stocked in the home.
When to use emergency medications
- Use the usual oral medications (e.g. painkillers) first. If they are not helping, call the PCSE team
- PCSE nurses will review symptoms and administer medications if necessary and review any changes necessary to regular doses
- Keep a record of the medications administered as this is helpful in an emergency
Let the PCSE team know if the person’s condition changes. Medications and doses will be reviewed.
Who can give emergency medications?
- The PCSE team gives the initial ‘ready-to-inject’ emergency medications and can teach carers how to give the injectable medication
If you would like to learn to give the emergency medicines, please talk to the PCSE team. You will be taught about the medications, when they can be given, how to give the injection, how to record that the medications were given and who to contact for support. You will be provided with a care plan and the necessary equipment.
Looking after the emergency medications
- The medications are for the person you care for and should not be taken by anyone else
- Keep medications in a safe place out of reach of children or vulnerable adults
- Medications do not need to be kept in a fridge
Managing a syringe driver at home
As people become more ill, they may not be able to swallow tablets, capsules or liquid. When medications need to be given by injection, a small infusion pump called a syringe driver is used to dispense carefully calculated regular doses of medication over an extended period of time. The driver is managed by the PCSE team.
What you need to know
- The PCSE team will set up the syringe driver and will attend your home on a daily basis to refill the syringe with the required medications
- You will be taught to care for the syringe driver and fix any simple problems
- The nurse will prepare breakthrough medications and explain how/when to use these
- You, as the carer, are responsible for making sure that prescriptions for ongoing medications from the GP are filled by your pharmacy and ready in the home for PCSE staff to use at each visit
What you can do: tips for carers
DO: Check the battery daily, by checking that the light on the front of the syringe driver is flashing intermittently. DO: Only use the recommended DURACELL MN1604 9Volt Alkaline Battery (a spare battery will be supplied). DO: Check that the tubing is not kinked and the person is not lying on the tubing. Check for leakage from the tubing or the butterfly injection site. Your PCSE nurse will point out the common leakage points. DON’T: Get the syringe driver wet (do not take into steamy room or shower area). It is not waterproof. DON’T: Use a mobile telephone within one metre of the syringe driver.
The syringe driver has stopped before the syringe is empty
➜ Check that the line is not kinked or trapped
➜ Fit a new battery
☎ CALL PCSE
The light is not flashing
➜ Fit a new battery
The medication is leaking around the needle insertion site
☎ CALL PCSE
The syringe is empty before the nurse is due to arrive
☎ CALL PCSE
If you are unsure about managing the syringe driver, contact PCSE.
Fitting a battery
If the battery needs replacing:
- Slide the back cover off the syringe driver and gently tap out the battery. You can access this through the locked box at the back
- Fit a new 9 Volt battery and slide the cover on, holding the battery down
To restart the syringe driver:
- Press the on/off button on the front of the driver. When the screen asks ‘Resume Syringe Driver?’, follow instructions on LED display and press green YES button three times to resume and restart the syringe driver
To stop the syringe driver infusing e.g. if the person has died, remove the battery from the driver and call PCSE.
Giving medications by injection in the home
Sometimes, even when a person is receiving regular medications for their symptoms, they may have more pain or troublesome symptoms that need extra medication. This is given by injection and sometimes these can be administered at home without the nurse.
The PCSE team will teach you how to give injections. You do not have to give these injections unless you are comfortable doing so. Let the PCSE team know if you want to stop giving injections.
What you need to know
The PCSE nurses put in an injection line, which sits under the skin. The injection is given into this line, not directly into skin.
- You will be taught what the medication is for and when to give it and shown how to record each injection given, writing the date, time and reason, and whether the injection was effective in relieving the symptom. Ask your PCSE nurse for an injection chart
- The PCSE nurses will label the prescribed medication in individual doses and it is kept at room temperature (for up to 48 hours) with a sterile cap covering until required
- You will be taught how to safely dispose of any used needles and syringes
- There will be an additional injection available for any uncontrolled pain. You can repeat in 30 minutes if the person is still in pain
- The PCSE nurse will review the person’s medication dosage regularly and adjust it if necessary, in consultation with the GP
If pain is still there 30 minutes after the second extra injection, call the PCSE team for further advice.
If the person you are caring for is dying, an injection may relieve their discomfort and pain at this point. This is quite common and does not hasten their death.
You WILL feel better