News and updates from

Selected items from the News and Latest Additions sections of, the world’s leading palliative care website with over 30,000 members from 169 Countries.

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Updated Do Not Attempt Cardiopulmonary Resuscitation policy

The Scottish government has published an update to NHS Scotland’s Do Not Attempt Cardiopulmonary Resuscitation policy for adults. For more information, click here.

British guideline on management of asthma updated

The 2016 update to the BTS/SIGN British guideline on the management of asthma is now available. It includes a complete revision of the sections on diagnosis and pharmacological management of asthma, and updates to the sections on supported self-management, non-pharmacological management of asthma, acute asthma, difficult asthma, occupational asthma, and organisation and delivery of care.

A summary and the full guideline can be downloaded from both the BTS and the SIGN website. Additional supporting material are also available on the SIGN website

 NICE Consultation: Care of dying adults in the last days of life

NICE has published a draft quality standard for consultation on the care of dying adults in the last days of life. There are four quality statements listed:

  • adults who have signs and symptoms that suggest they may be in the last days of life are monitored for further changes to help determine if they are nearing death, stabilising or recovering
  • adults in the last days of life are given care that is in accordance with their stated preferences and responsive to their changing preferences
  • adults in the last days of life who are likely to need symptom control are prescribed anticipatory medicines with individualised indications for use and dosage
  • adults in the last days of life have their hydration status assessed daily, and a discussion about the risks and benefits of clinically assisted hydration.

The deadline for consultation responses is 27 October 2016. For more information, click here.

NICE guidance on multimorbidity

NICE guideline (NG56) multimorbidity: clinical assessment and management is now available.

Drug updates

Palladone (hydromorphone) SPC updated

Both immediate-release and modified-release Palladone (hydromorphone) capsules are now authorized to be opened and the granules sprinkled onto soft food for administration where necessary. However, the granules of the modified-release formulation must be swallowed whole and not crushed, broken or chewed as this can lead to a rapid release and absorption of a potentially fatal dose of hydromorphone. For more information, click here.

Authorized glycopyrronium oral solution now available in UK

A glycopyrronium 200microgram/mL (1mg/5mL; Colonis Pharmaceuticals) oral solution is now available, costing £91 for 150mL. It is authorized for the treatment of peptic ulceration, thus use in indications in palliative care, e.g. drooling would be off-label. However, a glycopyrronium 320microgram/mL oral solution, authorized for severe drooling, is expected to be launched soon (see our news item 28 July 2016). For more information, click here.

Glycopyrronium 200micorgram/ml (1mg/5mL) oral suspension, although cheaper (when comparing 28 days’ cost @ 1mg t.d.s.), remains an unauthorized product via special order.

SMC accepts diamorphine nasal spray

The Scottish Medicines Consortium has accepted diamorphine nasal spray (Ayendi; Wockhardt) for the treatment of acute severe nociceptive pain in children and adolescents in a hospital setting. It should be administered in the emergency setting by practitioners experienced in the administration of opioids in children and with appropriate monitoring. For more information, click here.

Latest additions

PCF5+ 2016 pdf available soon!

PCF5+ 2016 pdf version is anticipated to be available in November 2016. We are pleased to announce that we will be able to keep the cost of this version at £25.

This annual version of the PCF will contain the updates made to the on-line PCF over the last 12 months since the last pdf version (PCF5+ 2015 pdf), and will reflect the content of the website as of 1st September 2016.

The on-line formulary will still be continually updated, providing the most up to date version. The more members subscribe, the more we can reduce the cost of subscription. We would like to thank you for your support over the last 12 months. Please note if you require bulk purchases of the pdf format please contact to discuss your requirements.

Survey results: Withdrawal of ventilation at the request of a patient

Results from our survey (August-September 2016).

The Association of Palliative Medicine (APM) produced guidance for professionals on the withdrawal of assisted ventilation at the request of patients with motor neurone disease in 2015, and is now collating experiences for ventilator-dependent patients with a broader range of conditions who request that their assisted ventilation be stopped. It is hoped that this may inform guidance for other groups of patients in future editions of the guidelines. UK health professionals involved in supervising ventilator withdrawal are encouraged to complete the audit of process and outcomes which is available, alongside the current guidance, on the APM website.

 Prepared by Sarah Charlesworth and Andrew Wilcock

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