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Anticipatory syringe drivers: a step too far
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  • Published on:
    Response to "anticipatory syringe drivers: a step too far"
    • Paul Howard, Consultant in Palliative Medicine Mountbatten Hospice and St Mary's Hospital, Isle of Wight
    • Other Contributors:
      • John Curtin, Consultant in Palliative Medicine
      • Bev Behmer, Clinical Nurse Specialist and Community Palliative Care Team Leader
      • Sandra Clawson, Clinical Pharmacist in Palliative Care
      • Dee Curless, Nurse Consultant in Palliative Care

    Dear Editor,
    We read the editorial with interest. As they rightly observe, there are important problems prescribing anticipatory syringe drivers. However, we believe there are selected circumstances where it can be an important contribution to timely symptom management, provided all the following are true:
    1. There is a foreseeable distressing circumstance that can be unambiguously identified by all of the health professionals seeing the patient (including those out of hours and without ‘specialist’ experience)
    2.The medication choice and dose required is similarly foreseeable, unlikely to change, and can be safely initiated by all of the health professionals seeing the patient without additional expertise
    3.The initiation of the syringe driver reliably triggers a timely review by an appropriate clinician
    4.The patient and/or family is aware of the foreseeable need for a syringe driver, any concerns have been explored by an experienced practitioner and the anticipatory prescription done in accordance with their expressed wishes/preferences to achieve symptom control in their preferred place of care.
    Local service design will influence whether or not these criteria can be met. In our locality, patients have access to a community palliative care nurse 24hrs a day, changed circumstances are rapidly fed back by carers in the same community palliative care hub, and changes to regular medication doses can be identified because all community se...

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    Conflict of Interest:
    None declared.