Posted by: Ayla Atalar19 APR 2013
I feel extremely lucky to have had my palliative care rotation in an actual palliative care centre where patients come in to either receive symptom control or to have end of life care.
Overall, palliative care is the active holistic care of patients with advanced progressive illness. It has many aims, with one of them being to support end of life by making the patient as comfortable as possible and controlling their symptoms. In relation to pharmacy, we are faced with the issues of rationalising medicines, using drugs outside of their licence, changes in the way the drug is handled in the body and using lots of controlled drugs.
Discussing palliative care pharmacy would definitely take more than a blog post, but here are a few things that stick out in my mind;
- Ensure that patients have appropriate pain management – there is no ceiling dose when using opioids for palliative care!
- Opioids cause constipation so ensure a suitable laxative is prescribed (from my experience docusate was the softening laxative of choice)
- Dexamethasone is used for its anti-inflammatory effects to reduce the tumour but, as it is a steroid, can make the patient hungry. This is a disadvantage if the patient has difficulty eating, but good if you want the patient’s appetite to improve. PPIs are also commonly prescribed with steroids
- When using syringe drivers it is extremely important to make sure the drugs are compatible and do not interact
- Glycopyrronium is used to reduce the excess bodily secretions that are common in the last stages of life
One other big learning point is that the patients should be asked about their opinions on their care. Some patients would prefer to live for as long as possible even if it means they might be in pain, whereas others have a different view.
I can now proudly say I have had first hand experience of healthcare professionals working excellently together to provide the best possible care to patients in the last days, hours and moments of their lives.