This guidance helps people who are caring for a person for whom recovery is uncertain, or who may be in the last days of life. It aims for the best care possible when access to, or ability to, administer subcutaneous injections is unavailable. It is designed to be used alongside the Somerset symptom assessment chart, which can guide and support when to give medicines to alleviate or stop distressing symptoms.
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Where possible ensure an open window with a flow of air. The sensation of airflow on the face can be hugely helpful.
Assist the person into a comfortable position. Leaning forward can help. Perhaps rest forward onto a few stacked pillows, if able.
Cool the face using a damp cloth. Cool the centre of the upper chest (sternum) as well, if able.
Use oxygen if this is present and prescribed.
Medication to give:
Relax breathing effort: 2.5mls (5mgs) of oral morphine solution (Oramorph). Doses repeated every 2 hours if required.
Relax the person: If required, give 0.5 – 1mg lorazepam under the tongue. This can repeated after 4 hours, a maximum of 4mg in a day.
Paracetamol 1g can be administered. If difficult to swallow, the tablets do dissolve in water even if they are not the “soluble” variety, and the taste can be disguised with juice. A maximum of 4g in a day.
Diclofenac 100mg suppositories can be used to treat pain and reduce fever, if paracetamol cannot be taken.
These can be used once daily.
Oramorph 2.5mls (5mg) can be given to ease any pain every 2 hours, if required.
Cover the mouth and nose with a tissue when sneezing, coughing, blowing or wiping the nose. Wash hands after disposing of tissues. Refer to government guidelines on disposal of tissues.
A drink of honey and lemon or sucking cough sweets can help to soothe the throat. Avoid smoking.
Medication to give:
Oramorph 2.5mls (5mg), repeated every 2 hours if needed
Remove any triggers for nausea, for example strong smells, where possible.
Try to keep the persons mouth clean and moist using small amounts of water on a soft toothbrush.
Medication to give:
Give half a levomepromazine 25mg tablet = 12.5mg. This can be dissolved in a small amount of water if unable to swallow tablet.
If this does not help, apply a scopoderm 1.5mg patch behind the ear. Every 3 days remove and apply a new patch behind the other ear.
Try to reorientate the person who is confused. Reassure them that you are there to help them.
If the person feels agitated then check they do not have a full bladder, or need to open their bowels.
Medication to give:
If they have any pain then treat this with Oramorph as above.
Lorazepam 1mg under the tongue can be used to ease agitation. Up to 4mg in a day.
Give one 25mg Levomepromazine tablet if the above measures have not helped.
A temperature of over 37.5C can be associated with shivering, chills and aches.
Aim to reduce the room temperature, wear loose clothing, cool the face with a damp cloth and provide fluids to drink as the person is able to do so.
Medication to give:
Give 1g paracetamol by mouth if able to swallow. Maximum 4g in a day. If not able to swallow then the diclofenac suppository can be used. The suppository can be given daily if needed.
Move the person onto their side and reposition as much as possible, see if they can be moved into the recovery position. Noisy breathing distresses those with the person usually more than the person themselves.
Medication to give:
Apply one scopoderm 1.5mg patch to the skin below the ear behind the jaw. Every 3 days remove the patch and apply a new one to the other side
If you give medication to help one symptom, such as pain, then it will also relieve other symptoms the medication is indicated for.
If you need guidance or support then call St Margaret’s Hospice Care advice line on
01823 333822 or 0845 0708910;
they will ask you for details in order to help them assess and assist your situation.
They may advise a repeat dosing of the medication.
If you are known to Weston hospice care, their number is 01934 423900. Dorothy House Hospice is
0345 0130 555