Prescription: Palliative Care: Morphine PRN

Casebank Prescription
1

Scenario 1

Where you are
You are FY2 in hospice care home
Who the patient is
Mrs. Maria Smith, aged 80, is diagnosed with metastatic pancreatic cancer

Other information
Patient is terminal palliative care has been prescribed. She has been referred from hospital to hospice
for the continuation of palliative care. She cannot eat or drink.

Special Note
None

What you must do
Write down the prescription of her palliative caste medications

Hospital Handover Note
Patient name: Maria Smith
Date of Birth: 25/03/1942
NHS Number:123456
Hospital No: 1234
Allergy: Penicillin, Reaction: Breathlessness

Dear Doctor,
Mrs. Maria Smith, aged 80, has been admitted in the Hospice Care Home with pancreatic cancer. She is
terminally ill and cannot eat or drink.

Plan:

  • Morphine 5mg SC every 4 hours (maximum 30mg) for pain.
  • Cyclizine 50mg TDS SC (maximum 150mg) for nausea and vomiting.
  • Hyoscine bromide 400 micrograms SC 4 hourly (maximum 2.4mg) for secretion.
  • Paracetamol 1g PO every 4 to 6 hours (maximum 4 g/day) for pain.
  • Atorvastatin 10mg PO OD

Scenario 2

Where you are
You are an FY2 in Hospice care home.

Who the patient is
Mrs Victoria Yates, aged 80, is diagnosed with metastatic pancreatic cancer.

Other information you have about the patient
Patient is terminal. Palliative care has been prescribed.
She has been referred from the hospital to hospice for the continuation of the palliative care. She cannot eat or drink. Her list of medications can be found in the hospital handover inside the cubicle.

What you must do
Write down the prescription for the above medications.

Special note
None

Hospital Handover Note
Patient name: Victoria Yates
Date of Birth: 25/03/1942
NHS Number: 123456
Hospital No: 1234
Allergy: Penicillin, Clarithromycin
Reaction: Rash, Rash

Dear Doctor,
Mrs Victoria Yates, aged 80, has been admitted in the medical department with pancreatic cancer. She is terminally ill and on palliative care. She cannot eat or drink.

Plan: She will be discharged to hospice for palliative care with the following medications.

Other medications:

  • Morphine 5 mg SC every 4 hours for pain PRN
  • Cyclizine 50 mg SC every 8 hours for nausea and vomiting PRN
  • Midazolam 2.5 mg SC every 4 hours for agitation PRN
  • Hyoscine Bromide 400 micrograms SC every 4 hours for secretion PRN
  • Paracetamol 1 G PO QDS
  • Atorvastatin 10 mg PO OD

Shortcut:

  1. Only give PRN: Morphine, Cyclizine, Hyoscine, Midazolam
  2. Stop oral drugs: Paracetamol & Atorvastatin
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