Canterbury DHB

Context

Discharge Checklists for Subcutaneous Infusions

Patients must be using a Niki T34 syringe driver when discharging from hospital. This is the case regardless of whether they are going home, to a residential care facility to a rural hospital or to Hospice. An appropriate medication authority is required (see below). The Palliative Care Service can supply syringe drivers for use during transfer if needed.

In This Section

Discharge Checklist for Patients going home on a Subcutaneous Syringe Driver

Discharge Checklist for Patients transferring to Residential Care/Rural Hospital on a Subcutaneous Syringe Driver

Family Administration of Subcutaneous Medications

Discharge Checklist for Patients going home on a Subcutaneous Syringe Driver

  1. As soon as discharge is confirmed, refer to "Palliative Care" under Community Nursing on the Canterbury Care Coordination Centre (CCCC) referral form. Fax this referral the day before discharge wherever possible so that a District Nursing Provider can be allocated. Ensure that the subcutaneous infusion is emphasised on the referral as it will require daily changes.
  2. Ensure medication scripts for the infusion are faxed to the community pharmacy in advance of the discharge – the original scripts must then be posted to that pharmacy. Do not give the original to the patient / family. No script is needed for the diluent (usually water for injection). Family should be advised to collect the medications promptly from the community pharmacy so that they are in the house at the time the nurse visits to change the infusion the following day.
  3. Ensure that an Authority Form is completed and fax through with the CCCC referral form. The original form should accompany the patient at discharge to be used daily by the District Nurse. Please use the Nurse Maude "Authority for Administration of Prescribed Medication via Continuous Subcutaneous Infusion" (Document No:7418) for all patients irrespective whether they are under the care of Nurse Maude, Healthcare NZ, Access Home Health or Rural GP teams. Also use the "Authority for Administration of Prescribed Medication" (Document No:4203) for all bolus to be given subcutaneously in the community.
  4. There are 2 options for ensuring that a syringe driver is available for the transfer home:
  5. In order to keep the patient comfortable on the journey home, a bolus dose of analgesia may need to be given prior to leaving the ward. This may be required regardless of whether the infusion is suspended or not.
  6. If the patient is complex or problems are anticipated, contact the Nurse Maude Hospice (375 4274) and speak to one of the palliative care nurses). The palliative care team at the hospice assist District Nurses with symptom management and will be more able to do this if given some advanced warning. Also, ring the GP, informing them of the arrangements. If discharging an unstable patient with a syringe driver on a Friday, advise the GP the day prior if possible to facilitate a visit if needed. It is helpful to advise the patient/family that prompt and regular GP review in the community is essential.

Commonly used subcutaneous medications (in ampoules) are:

Morphine Sulphate - 10 mg/mL, 30 mg/mL

Morphine Tartrate - 120 mg/1.5 mL, 400 mg/5 mL

Oxycodone - 10 mg/mL, 20 mg/2 mL, 50 mg/mL

Haloperidol - 5 mg/1 mL

Cyclizine - 50 mg/mL

Metoclopramide - 10 mg/2 mL

Hyoscine Butylbromide (Buscopan) - 20 mg/mL

Clonazepam Ampoules - 1 mg amps (with diluent)

Dexamethasone Ampoules - 4 mg/mL amps

Midazolam Ampoules - 5 mg/5 mL, 15 mg/3 mL

Please supply one week's worth of medications.

Discharge Checklist for Patients transferring to Residential Care/Rural Hospital on a Subcutaneous Syringe Driver

  1. As soon as a Residential Care Facility and date of discharge has been confirmed, contact must be made with a registered nurse at that facility to inform them that the patient is discharging on a subcutaneous infusion. Most facilities will use the Niki T34 syringe driver but it is advisable to check with the registered nurse to ensure that a syringe driver is available.
  2. Prescriptions for the medications within the syringe driver may need to be faxed to the pharmacy used by that facility the day before discharge to ensure that medications are available. Ask about this when ringing to confirm the transfer. No script is needed for the diluent which is usually water for injection. (Note: no scripts are needed for patients transferring to the Hospice).
  3. Generally, the infusion will be suspended as the patient leaves the ward (the subcutaneous cannula is capped). In order to keep the patient comfortable until the new infusion is started in the facility, bolus doses can be given of some or all the medications prior to leaving the ward.
  4. Ensure that an "Authority for Administration of Subcutaneous Prescribed Medications via Pump" form (C260037) is completed and included within the discharge papers.
  5. If the patient is transferring to a facility some distance from Christchurch it may not be appropriate for the infusion to be stopped. In this case, transferring the patient with a Niki T34 syringe driver may be necessary. This can be arranged with the assistance of the Hospital Palliative Care Service who are able to loan out a syringe driver to cover the transfer period. The syringe driver must be returned as soon as possible.
  6. If the patient is complex or problems are anticipated, contact the Nurse Maude Hospice and speak to one of the specialist palliative care nurses (375 4274). The specialist palliative care team at NM assist Residential Care staff with symptom management and will be more able to do this if given some advanced warning. Also, ring the GP informing them of the arrangements. Ideally ring the day prior to facilitate the initial GP visit.

Commonly used subcutaneous medications (in ampoules) are:

Morphine Sulphate - 10 mg/mL, 30 mg/mL

Morphine Tartrate - 120 mg/1.5 mL, 400 mg/5 mL

Oxycodone - 10 mg/mL, 20 mg/2 mL, 50 mg/mL

Haloperidol - 5 mg/1 mL

Cyclizine - 50 mg/mL

Metoclopramide - 10 mg/2 mL

Hyoscine Butylbromide (Buscopan) - 20 mg/mL

Clonazepam Ampoules - 1 mg amps (with diluent)

Dexamethasone Ampoules - 4 mg/mL amps

Midazolam Ampoules - 5 mg/5 mL, 15 mg/3 mL

Please supply one week's worth of medications.

Family Administration of Subcutaneous Medications

About this Canterbury DHB document (116356):

Document Owner:

Kate Grundy (see Who's Who)

Issue Date:

March 2016

Next Review:

March 2018

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 116356