Background

The focus of this guideline is to reduce the suffering for those dying from COVID-19 lung disease.

A proportion of patients dying of COVID-19 lung disease could have severe symptoms with rapid decline. In this situation it is important to deliver effective medications, at effective doses, from the outset. Early management of symptoms will be the most effective way to reduce suffering. 

The clinical profile of COVID-19 lung disease driven dying is likely to include:

  • High breathlessness/‘air hunger’ 
  • High distress
  • High delirium/agitation
  • High fever
  • Risk of cessation of life over a short number of hours.

In this context, this guidance has been drawn up to enable confidence in prescribing and using responsive rapid titration for standard anticipatory doses and broader prescribing ranges for professionals caring for people imminently dying from COVID-19 in any setting.

This guideline should only be used when reversible causes for deterioration have been addressed and there is consensus that the patient is dying.

This guideline does not replace existing local and Scottish guidelines for symptom management (Scottish palliative care guidelines) for all other clinical situations, and advice should be sought from your local palliative care team when needed.

This guidance has been developed by a rapid review process and independent reviews. It will be reviewed on a weekly basis as further evidence occurs. 

Use of initial subcutaneous or intravenous bolus medications in severe symptoms alongside early commencement of syringe pumps is strongly recommended. This is because syringe pumps take at least 4 hours to reach full effect. If a syringe pump is not available then consider alternatives. Refer to: Alternatives to regular medication normally given via a syringe pump.

Route of delivery will depend on the individual clinical setting. Subcutaneous dosing is interchangeable with intravenous dosing where that route is available and more familiar.

 

note: syringe pump and syringe driver are both relevant terms