It is better to be prepared in anticipation to support calm management in the event of their occurrence, than to be unprepared. Ensure that family and staff know how to access care including 24hr advice. Ensure that you reassess the situation after an agreed time period, listening to the family and staffs concerns. Communicate well between professionals and family, ensuring clear documentation of symptom progression and management. In all of your assessments: Ensure that you have time to adequately listen and assess Take each decision with adequate reflection upon the factors involved Discuss regularly with colleagues Don’t be afraid to say that you don’t know and be willing to seek advice from others In terms of treatment: Keep treatment as simple as possible Stick to one drug per symptom where possible Involve the child & family in decisions re treatment choices Manage with oral preparations where possible Plan for anticipated symptoms Listen to the child & family’s account Ensure management is reviewed in an agreed manner Consider the use of a syringe pump if the child is: No longer able to absorb oral medication Vomiting Having difficulty swallowing and has no NG tube/gastrostomy Is not fully conscious Remember to check compatibility of any drugs in a syringe pump and never put more than three drugs in any one pump. For the oncology/haematology children it is useful to agree a protocol for the administration of blood products support, before a crisis is reached. This should be based on the instructions of the child’s consultant. Regularly review the overall medications being given. Do all remain necessary? Consider rationalising drug use, especially in the final days.
Algorithms to Support Urgent Symptom Management Out of Hours The following algorithms have been developed to support urgent decisions that may need to be taken to manage symptoms effectively out of hours when specialist advice is not readily available, in end of life care. They provide a guide to the approach to the symptom management and to the possibilities for drug choice and other means of symptom management. Where a drug is to be considered, its dosages can be found in the APPM 2017 or the BNF for children. Wherever possible symptoms should be anticipated both in terms of how to manage them and in terms of the drugs that would be required to do so. The advice within the algorithms acts as supplementary information at times of unexpected events that may at times occur in end of life care. The Algorithms relate to: Nausea/Vomiting Breathlessness Seizures Pain Bleeding and Agitation
Troubleshooting Problem: Possible cause: Action: The pump will not start No battery present Battery inserted incorrectly Battery is depleted/very low Pump is faulty Fit a battery Re-align battery terminals Fit a new battery Service required Infusion ended early/going too quickly Incorrect rate set Wrong syringe brand selected during set up Pump faulty or incorrectly calibrated Check displayed rate against prescription change if necessary Ensure correct understanding of user Service/calibration required The pump has stopped before emptying syringe Exhausted battery Faulty pump Fit new battery, turn pump on, confirm syringe size and brand select to resume infusion Return for service CME T34 Pump Alarms When the pump detects a problem four things occur The infusion stops An audible alarm is activated A message appears on the display screen indicating the cause of the alarm The LED indicator turns red