Objective: To evaluate our current practice in the use of syringe drivers in End of Life Care in Parkinson’s Disease.

Background: Palliative care in advanced Parkinson’s disease (PD) recognises the need to move from attempting to control function to affording comfort measures.1 For patients unable to swallow in the terminal stage, medication can be administered subcutaneously as needed or continuously using a syringe driver.2 If necessary medication can be given for specific symptoms such as: -Morphine for pain -Hyoscine butylbromide for drooling or chesty secretions -Cyclizine,ondansetron and levopemromazine  for nausea or vomiting.  Although there is lack of robust national guidance on choice of medications to be used in End of Life Care in Parkinson’s Disease, there is consensus on avoiding the use of certain medications in PD such as Haloperidol and metoclopramide due to risk of worsening of Extrapyramidal Symptoms (EPS) and QT interval prolongation.3

Method: Parkinson’s patients who had passed away in hospital between 1st January and 31st December 2017 were identified by Medical Informatics. Data on demographics, review by Hospital Palliative Care team, use of syringe driver and ‘just in case medications’ was collected on a proforma. Information was gathered from clinical notes and Electronic patient records.

Results: A total of 38 patients (33 males) were identified with an age range of 61-95 years (average 80.5 years) .The range of Parkinson’s duration was 1-18 years (average 7 years). 28/30(73%) were reviewed by the hospital palliative care team and End of Life Care Pathway was commenced in 25/38 (65%) patients. Total number of patients commenced on syringe driver was 25/38 (65.8%).The breakdown of contents of the syringe driver is shown in table 1. 4/38(10.5%) of patients achieved symptom control with  medications as required whilst  9/38(23.7%) did not require any palliative medications.

Conclusion: Choice of medications in End of Life Care in Parkinson’s Disease requires careful understanding of drug interactions and side effects. In our patient cohort, morphine and midazolam are the drugs of choice for optimal symptoms control. There was over all good practice in recognition of medications (to avoid haloperidol and metoclopramide) in syringe drivers for such patients.

References: 1-http://www.clinmed.rcpjournal.org/content/10/3/290.full?related-urls=yes&legid=clinmedicine;10/3/290 2-BNF Prescribing in Palliative Care London BNF 2009 https://bnf.nice.org.uk/guidance/prescribing-in-palliative-care.html 3- Anticipatory prescribing of ‘Just in Case’ medication for symptom control in the last days of life in adult community palliative care patients STANDARD OPERATING PROCEDURE AND CLINICAL GUIDELINES FOR BRISTOL, NORTH SOMERSET AND SOUTH GLOUCESTERSHIRE;13/01/2014

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MDS Abstracts - https://www.mdsabstracts.org/abstract/use-of-syringe-driver-in-end-of-life-care-in-parkinsons-disease-pd/