Why a Syringe Driver Chart? - Palliative Care Resources

October 2011Information on how to use the Community Syringe Driver ChartThis chart is designed specificallyfor prescribing medication to beadministered in a syringe driver.It is currently being used in theSelby & York localityWhy a Syringe Driver Chart?The chart incorporates many new safety features to reduce the potential for error whenprescribing and setting up.• Information is contained on the front of each chart for both prescriber and nurses to helpo Prescribing, monitoring, observations & administration.• A monitoring record on the chart to ensure the syringe driver is functioning correctly.• A checklist for reference in the event of syringe driver failure.• Limited space to prescribe regular medications to promoteRationalisation of drugs used for patients on the Liverpool Care Pathway forthe dying patient (LCP).• Remember to document if the patient is on an opiate patch. Fentanyl or Buprenorphine patches will affect the PRN injectable opiate dosesand doses prescribed in the syringe driverSo, what’s new?Guidance for prescribers is available on the front of each chart. This includes advice for prescribing,documenting calculations in medical notes and calculating prn opiate dose ranges.Information for prescribers• Prescribe approved name of drug entered in CapitalsCancel Drugs• Discontinue prescriptions by clearly crossing through the whole prescription, with the date discontinued & signature.• Do not alter an existing prescription always rewrite a new syringe driver prescription in a new box.• There is enough space for 2 syringe driver prescriptions on each syringe driver chart• Check for allergies• Check drug combinations are compatible in the syringe driverOpiates• Prescriptions for opiates & CDs must be prescribed in words and figures. CDs now include Midazolam & Phenobarbitone• Use whole numbers. Do not use decimals.• Dose calculations must be documented in the medical notes• Remember to prescribe medications for subcutaneous use on the PRN (when required) chart• The PRN opiate dose ranges should reflect the syringe driver dose (one sixth of the 24 hour dose of opiate)• The PRN opiate dose should also take into consideration whether a patient has a Fentanyl patch in situ.• Calculate the increased opiate dose requirements for the next syringe driver based on the number of additional prn doses overthe previous24 hours (providing the pain is opiate sensitive)Diluents• Generally use water for injection.• Never use 0.9% saline with Cyclizine as it will crystalliseUse 0.9% normal saline for• Levomepromazine by itself• Syringe driver combinations containing Octreotide, Methadone, Ketorolac or KetamineSyringes• Usually use 10ml & 20ml syringes but occasionally 30ml syringes may be required.

Syringe Driver Record and Monitoring ChartSyringe driver checklistDate & Time of S/D check 12/01/11 13/01/11Date of battery insertedSyringe sizeYes10mlSyringe labelled Yes or No YesIs indicator light flashing?Yes or NoAre the drugs in syringe clear?Yes or NRate of infusion in mmYesYesRate set correctly ? Yes or No YesVolume left in syringe at S/DchangeSite of Infusion2mm/hr48mmR armSigns of inflammation Yes or No NoPrint NameSignatureA.NURSEA. NurseYes10mlYesYesYes2mm/hrYes48mmR armNoA.NURSEA. NurseThis section must becompleted each time a syringedriver is set up.Document:• Date & time of SD check• Battery inserted• Indicator light flashing• Syringe size• Syringe labelled• Site of infusion• Rate of infusion in mm• Rate set correctly• Volume left in syringe• Signs of inflammation• Check drugs in syringeclear• Nurse’s name & signatureThis checklist should befilled in each time theSyringe driver ischeckedRate set• always check therate is correctGuidance for checking is available at the bottom of the MonitoringChart. If the driver is found not working correctly, refer to theadvice within this section.Is the syringedriver working ?•check battery• When wasbattery changed?• check startbutton•check set upWhat is thecurrent ratesetting ?Is S/D runningon time?• too fast - checkrate setting andcalculation•too slow – checkbattery•check tubing forkinking•check site forblocked cannulaor inflammationCheck patient forsymptoms• if required givePRN dose of theappropriate drugas prescribed onthe PRN sectionof the chartSyringe contents•check drugs insyringe are clear– no crystallisationInfusion Sitecheck appearancefor inflammation,irritation,induration orinfectionCheckconnections• check syringe /tubingconnectedA check on the syringe driver must be made at least daily anddocumented appropriately on the chart.

For Action nowNurses must ensure that:• Information provided on the front of each chart is read, understood and that the guidanceis followed.• Syringe driver checks are adhered to and documented on the syringe driver chart.• A syringe driver should only be set up by nursing staff (or other HCPs) who have had theappropriate syringe driver training.Information for PrescribersPrescribers must ensure that:• the new chart is used for prescribing all syringe drivers.• the prescriptions for opiates are prescribed in words and figures.• for patients on the Liverpool Care Pathway (LCP)o refer to the LCP documentation and syringe driver policy and rationaliseprescriptions for other medications.NB In renal failure Morphine/Diamorphine accumulates.Patients with a GFR