Palliative Care

Below are some guidelines for symptom control in palliative COVID-19 patients. The drugs and doses are also suitable for terminal patients who may not have COVID-19.

Nursing Home - Palliation of COVID-19 Patients in their Nursing Home

If patients are from Dubbo Nursing homes and they are Palliative – starting a syringe driver here at DBH and sending them back to their Nursing Home might be a suitable plan. A lot of the nursing homes carry ward stock of Morphine and Midazolam but not a large volume of each drug. They will need to be charted on a medication chart (see below).

Syringe driver starting dose recommendations:

ALL CSCI (continuous subcutaneous infusion) via syringe drivers:

• Morphine 15-20mg/24hrs

• Midazolam 10-15mg/24hrs

• Glycopyrolate 600mg/24hrs

Breakthrough doses:

• S/C Morphine 2.5-5mg q1h PRN for dyspnoea and pain (no max dose)

• S/C Midazolam 2.5-5mg q1h PRN for agitation/restlessness/dyspnoea (no max dose)

• S/C Glycopyrolate 200mcg q4h PRN for respiratory secretions (MAX DOSE 1200mcg/24hrs)

 If severely renal compromised HYDROmorphone should be considered  (please note ALL Dubbo Nursing Homes DO NOT have ward stock supplies of this drug)

Syringe driver starting dose recommendations:

• HYDROmorphone 3-5mg/24hrs

Breakthrough doses:

• S/C HYDROmorphone 0.5-1mg q1h PRN for dyspnoea and pain (no max dose)