Palliative Care Guidelines

Adapted from Christchurch Hospital Palliative Care Service guidelines – with thanks.

Reviewed by Waikato Hospital Palliative Care Team - July 2008

Contents

1. Management of persistent pain in the palliative setting

1.1 Mild to moderate pain
1.2 Opioid Therapy for severe pain
1.3 Morphine
1.4 Other opioids
1.5 Prescribing of opioids

2. Co-Analgesics

2.1 Corticosteroids
2.2 NSAIDs
2.3 Tricyclic antidepressants
2.4 Anticonvulsants
2.5 Ketamine
2.6 Benzodiazepines
2.7 Baclofen
2.8 Neuroleptics
2.9 Bisphosphonates
2.10 Calcitonin
2.11 Referral to other services

3. Nausea and vomiting

3.1 First-line antiemetics
3.2 Second-line antiemetics

4. Constipation

4.1 Laxatives
4.2 Enemas
4.3 Severe constipation

5. Intestinal obstruction

5.1 General considerations
5.2 Medical management

6. Dyspnoea

6.1 Morphine
6.2 Benzodiazepines
6.3 Steroids
6.4 Oxygen

7. Cough

7.1 Dry cough
7.2 Productive cough

8. Respiratory tract secretions
   
   
9. Hiccoughs
   
   
10. Dry mouth
    

10.1 Oral care


11. Sweating
    
    
12. Itch/ Pruritis
    
    
13. Agitation
    
    
14. Delirium
    
    
15. Care of the imminently dying

15.1 Excessive airway secretions (death rattle)
15.2 Terminal agitation

16. Subcutaneous administration of medications

16.1 Subcutaneous bolus medications

17. Guidelines for referral to the Palliative Care Service

17.1 Referral is appropriate when
17.2 How the Palliative Care Team work
17.3 Making a referral

References, resources and authors

DISCLAIMER

Every effort has been made to ensure the accuracy of this text, and that the best information available has been used. This does not diminish the requirement to exercise clinical judgement, and neither the publishers nor the authors can accept responsibility for its use in practice.

Information last reviewed: June 2009	Please foward any enquiries about this document to haggars@waikatodhb.govt.nz
Next review date: July 2010	For Palliative Care advice, please call 8691 or the specialist on-call.

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