What can I do?
When reviewing medications, consider the place of care, availability of medications and equipment, and who will be available to manage the medications.
When considering the use of a syringe driver, consider:
- the practicalities - clothing, bathing, showering, sleeping position
- the medication transition from oral to subcutaneous; a breakthrough dose is usually given to ensure there is not a gap in medication
- drug compatibilities.
Explain to carers and the client or the resident and carer(s) the benefits of a syringe driver.
Check whether those providing care have the skills to manage a syringe driver.
The use of the syringe driver needs to be done in consultation with the person, carer, and family, in a manner that ensures that any concerns are addressed. These may include:
- reassurance that if the person continues to experience symptoms, breakthrough medication can be given on these occasions
- an explanation that a syringe driver allows the symptoms associated with the process of dying to be managed, without speeding up the process of dying
- addressing any concerns or anxieties about the syringe driver, including the medications used, e.g. opioids
- concerns from previous experience with syringe drivers.
Choose the insertion site carefully if the person is agitated or distressed.
Ensure that the carer can check the site and battery level every four hours during the day and that they have access to 24-hour support.
Ask the carer to keep a record of when ‘as needed’ or ‘breakthrough' medications are used to control symptoms (such as pain, dyspnoea or nausea). Healthcare providers can use this information to adjust a person's medication or the mode of delivery of medication.
Use the syringe driver drug compatibility guidance (689kb pdf).
Remember that a syringe driver is a dynamic administration system which means that when multiple drugs are in the syringe driver, increasing the rate will increase the dose of all drugs in the syringe.
Use the resources from caring@home to help carers manage subcutaneous medications.
Provide a carry bag for the syringe driver to help the person to be mobile.