Is it wrong to request from GP a chart for syringe driver to be signed prior Resident getting worse? I need to mention Resident is admitted from Hospital with all EOL medication (Morphine Sulphate, Haloperidol, Glycopronium and Midazolam). This chart is needed if Resident deteriorates rapidly and Nurses need to use it.

Answered by Sheila Scott

Dear Diana,

I understand your question and the sensitivity surrounding it.

I think you should be able to discuss the matter with the GP and be able to come up with the right conclusion.

The GP may feel able to sign a prescription for the syringe driver, but it will be entirely up to the Doctor.

In the same way the hospital may be prepared to let you have one.

I asked Philippa Shirtcliffe, our Policy Clinical Lead for her advice and this is what she said:

“Pre-emptive prescribing’s (also known as anticipatory prescribing) aim is to encourage prescribers and other staff to think ahead and provide extra medications to manage the sudden changes in the service user’s condition. This can prevent a delay in management and ensures that medications are available in the time of need, and will allow the service user to remain in their chosen place of care. NICE guidelines do cover this  ‘Care of dying adults in the last days of life NICE guideline Published: 16 December 2015’  https://www.nice.org.uk/guidance/ng31/resources/care-of-dying-adults-in-the-last-days-of-life-1837387324357

If the nurse who is going to be responsible for setting up the driver, feels unsure or uncomfortable about it, she should work within the Code and seek advice prior to the situation arising. It may also be worth making sure there is a care plan and risk assessment in place plus adequate supplies of the medication, batteries etc.”

Best wishes.

Sheila