The National Core Community Palliative Care Medicines List (the List) identifies four medicines for use by home-based palliative patients in the terminal phase who require urgent symptom relief. Most common terminal phase symptoms in uncomplicated palliative care patients can be optimally managed using medicines from the List. Download the National Core Community Palliative Care Medicines List (158kb pdf)
The National Core Community Palliative Care Medicines List
| MEDICINE |
CLINICAL USES FOR THE TERMINAL PHASE |
| Clonazepam |
2.5mg/mL drops |
Agitation, anxiety, terminal restlessness, seizure |
| Haloperidol |
5 mg/mL injection |
Delirium, nausea/vomiting, terminal restlessness, refractory distress |
| Hyoscine butylbromide |
20 mg/mL injection |
Respiratory tract secretions/noisy breathing (prophylactic) |
| Morphine |
10 mg/mL injection |
Pain, dyspnoea |
Clinical context
Most palliative care patients say they would like to be cared for, and to die, at home. However, palliative patients are inherently unstable: deterioration can occur at any time and distressing symptoms can suddenly emerge. Palliative patients need timely access to symptom control medicines to avoid unnecessary suffering and/or unwanted transfers to inpatient facilities.
Recommendations
- General Practitioners, Nurse Practitioners and other prescribers caring for home-based palliative patients become familiar with prescribing and consider using the medicines in the List, where clinically appropriate
- Community pharmacists stock the medicines in the List to allow rapid dispensing and timely and easy access for patients
- State/Territory governments or local networks (e.g. Primary Health Networks, GP practices, community pharmacies):
- Promote the List to their networks
- Consider aligning State/Territory or local core palliative medicines lists to the List to promote standardisation of best-practice care.
Why was the List developed?
In response to requests from key national stakeholders, the Australian Government Department of Health and Aged Care supported caring@home to develop a core medicines list applicable across all Australian States and Territories. The List is a vital tool that will support standardised, quality palliative care by improving access to medicines in the community.
How was the List developed?
caring@home convened a national Working Party of clinicians (palliative medicine specialists, rural generalists, general practitioners, nurse practitioners, pharmacists, nurses) with representation from:
- ACT Health
- Agency for Clinical Innovation - End of Life and Palliative Care Network, New South Wales
- Australia New Zealand Society of Palliative Medicine (ANZSPM)
- Australian College of Nurse Practitioners (ACNP)
- Australian College of Rural and Remote Medicine (ACRRM)
- Australian Commission on Safety and Quality in Health Care (ACSQHC)
- Department of Health, Tasmania
- Metro South Palliative Care Service, Metro South Health Queensland
- Northern Territory PHN (NTPHN)
- Palliative Care Australia (PCA)
- Pharmaceutical Society of Australia (PSA)
- South Australia Health
- Safer Care Victoria
- The Royal Australian College of General Practitioners Ltd (RACGP)
- Western Australia Country Health Service (WACHS)
- Western New South Wales Local Health District (LHD).
The Working Party followed two Guiding Principles to determine medicines to include in the List.
- The List should be informed by the Palliative Care Therapeutic Guidelines, Therapeutic Goods Administration, and existing State/Territory lists of core palliative care medicines.
- Criteria when considering medicines to be included were:
- Evaluation of evidence for management of five symptoms common at end of life
- Consideration of the cost of medicines, including the availability of PBS subsidies
- If there is equivalent efficacy between two medicines consideration of both:
» medicines that can address more than one frequently encountered symptom
» most community friendly form of administration/transport/storage of medicine available.