Crisis pack prescribing in terminal haemorrhage: a national survey of specialist palliative medicine physicians

Objectives To establish practice among senior palliative medicine physicians regarding anticipatory prescribing to manage a terminal haemorrhage. To generate a guideline informed by data collected.Objectives To establish practice among senior palliative medicine physicians regarding anticipatory prescribing to manage a terminal haemorrhage. To generate a guideline informed by data collected.Methods An electronic questionnaire was sent to palliative medicine consultants and specialist registrars in Ireland.Results The response rate was 50%. All respondents (100%) prescribe crisis packs. The most prescribed medications were morphine and midazolam. Over 95% prescribe medication via the subcutaneous route. Regarding indications for prescribing, about two-thirds of respondents would prescribe for a patient with a head and neck malignancy. Almost two-thirds of respondents do not follow any policy or guideline. The main area of variation is in the dose prescribed for those already on a scheduled opioid and/or benzodiazepine.Conclusions The proposed guideline is based on the expert opinion of questionnaire respondents. The recommended medications, route of prescription and broad indications for prescribing included in the guideline were based on a clear consensus. Most respondents vary the dose of crisis medication prescribed based on whether the patient is on a baseline anxiolytic/opioid. As the calculations used for dose variation were not consistent between respondents, the most reported calculation, 1/6 of 24-hour dose, is recommended in the guideline.