When should I consider prescribing a syringe pump?
Patients likely to be in the last days / short weeks of life, those who are unable to swallow oral medications, and sometimes those with advanced life-threatening disease whose symptoms are uncontrolled with oral medications, may require medicines administered via the subcutaneous (S/C) or intramuscular (I/M) route.
Do I really need to prescribe injectable medications?
It is good practice that patients in the last days of life should always have anticipatory medication available to them in the home/ community setting to avoid a lapse in symptom control and distress for the patient and those close to them.
What is a MAAR chart and why do we need them?
A MAAR chart is a medication authorisation and administration record. It allows safe administration of medication in specific care settings where patients may be cared for by a range of professionals from different organisations.
What do I prescribe in the syringe pump?
NWL ICS have produced guidance for primary care on prescribing last phase of life anticipatory medicines
Please do consider the medication that the patient is already on, their current symptoms (i.e., inadequate pain control/ nausea/ secretions), and anticipate any future needs and prescribe a medication regime which is individualised for the patient.
You may find an opioid dose conversion table helpful.
To check whether your chosen drugs are compatible please see this link on mixing drugs in the syringe driver.
Where do I find the MAAR chart?
In the community, GP’s are now using electronic pan-London MAAR charts for prescribing syringe pumps and injectable medications (see example below). These have been integrated into EMIS and you may find them under the EOL template.
The clinician can complete the chart electronically:
- Provide full name and GMC number on pages 1-3 of chart.
- Type initials in the prescriber sign and print area for EACH medication prescribed.
- The completed chart can be emailed from the clinicians own nhs.net email address to another nhs.net email address.
In Hillingdon hospital, paper MAAR charts should be available on the ward. Alternatively there is one which you can print (see downloads).
How often do I need to review a MAAR chart?
There is no expiration date on the MAAR chart, however it is considered good practice to regularly review patients who are at the end of life or if the patient’s condition has changed. Medication requirements may increase/ decrease or stop.
Please see our services directory for pharmacies that stock EOLC medications in your borough.