palliative care

see also:

end of life care
neoplasia / cancer / tumours
NSW College of Emergency Nursing - End of Life guidelines (pdf)
NSW Govt - End of Life Care and decision making guidelines
Emedicine - the palliative care patient in the acute setting of ED
Safer Care Victoria - Checklist for care plan for preparing patient to die at home
Western Health nursing home patient prescribing process (intranet only):
- tips:
  - ALL patients returning to the RACF from ED with changes to their regular medicines require an IRCMAC
  - First print, then submit.
  - Always submit (otherwise it doesn’t save).
  - Sign your IRCMAC by hand when you have printed it, otherwise the nurses at the facility won’t use it.
  - Refer your patients to the Aged Care Liaison Service (ACLS) if they require follow up i.e. palliative care/IV ABx.
    - In hours: call intake 0419 392 030
    - After hours: fax a referral to 8345 0234

Patients CANNOT obtain newly prescribed palliative medications at the aged care facility after hours despite the above being performed HENCE these patients will most likely need to be admitted to hospital overnight for palliation if they cannot be transferred back to the facility by around 7pm so they can get the meds from an outside pharmacy (they do not have their own reserves)

common drug-related symptoms in palliative care

symptom	drugs which may cause or exacerbate symptom
fatigue	chemotherapy, chronic opioids, anticonvulsants
anxiety	corticosteroids, withdrawal of benzodiazepines, opioids or antidepressants
dry mouth	anticholinergics, opioids, antidepressants, antipsychotics, antihistamines, benzodiazepines, diuretics, anticonvulsants, PPIs
depression	corticosteroids
hiccups	corticosteroids, benzodiazepines, antipsychotics
drowsiness or delirium	opioids, benzodiazepines, antipsychotics, anticonvulsants, anticholinergics, corticosteroids
insomnia	corticosteroids
constipation	a multitude
restlessness	metoclopramide, opioids, antipsychotics
diarrhoea	laxatives, cholinesterase inhibitors, antibiotics, chemotherapy
sweating	cholinesterase inhibitors, opioids, antidepressants, sialogogues (eg. pilocarpine), tramadol