The Palliative Care Access to Core Medicines (PCAM) project aims to support palliative care in the community and assists people who wish to die at home through timely access to essential medicines. This minimises suffering associated with emergent end-of-life symptoms.
Eastern Melbourne PHN (EMPHN), South Eastern Melbourne PHN (SEMPHN) and North Western Melbourne PHN (NWMPHN) are proud to be partnering with The Pharmaceutical Society of Australia (PSA), the peak national organisation for pharmacists working in all sectors to deliver this project.
Core Medicine List Information
The Core Medicines List (CML) includes the medicines endorsed by the Australian and New Zealand Society for Palliative Medicines for use in community-based palliative patients and considered the core palliative care medicine lists published in other states.
This list was established first for the NWMPHN region through consultation with GPs, Pharmacists, and local palliative care providers. Utilisation of the existing core medicines list in EMPHN and SEMPHN regions ensures consistency across metropolitan Melbourne.
| Medicine category | First Line medicines | Minimum quantity to stock | Indication/s for use in terminal phase patients |
|---|---|---|---|
| Anxiolytic | Clonazepam 2.5mg/mL (0.1mg/drop) Oral Liquid
Midazolam 5mg/mL Injection (if an injection is required or preferred) | 10 mL bottle
5 or 10 ampoules | Agitation associated with delirium
Anxiety associated with dyspnoea |
| Antipsychotic | Haloperidol 5mg/mL Injection | 10 ampoules | Agitation, nausea, vomiting |
| Anticholinergic | Hyoscine butylbromide 20mg/mL Injection | 5 ampoules | Respiratory tract secretions Noisy breathing |
| Antiemetic | Metoclopramide 10mg/2mL Injection | 10 ampoules | Nausea, vomiting |
| Analgesic (high potency opioid) | Morphine (sulfate or hydrochlordie) 10mg/mL and/or 30mg/mL Injection | 5 ampoules | Dyspnoea, pain |
We are aware of some supply issues with metoclopramide injection, including the discontinuation of PBS-listed Maxolon. Alternative brands of metoclopramide have not yet been listed on the PBS, however as their cost is not prohibitively expensive, our recommendation to prescribers is to continue to prescribe metoclopramide as first line antiemetic medicine. Haloperidol injection is also an appropriate alternative therapy for nausea and vomiting in palliative care while these supply issues continue, however is more sedating.
Community pharmacies are encouraged to stock these first-line medicines as this is the recommended list that will be communicated in the region. Additional medicines to the list may be stocked dependent upon local prescribing preferences and/or stock availability.
This list does not restrict which medicines can be prescribed for individual palliative patients. This is one approach to help community pharmacies anticipate medicines most likely to be prescribed, and allow prescribers to anticipate medicines most likely to be available for rapid supply in community pharmacies within the EMPHN region.
This recorded webinar on Medicines in the last days of Life will equip general practitioners, community pharmacists, and other health professionals with knowledge about anticipatory medicines and medication management for end-of-life care.
Why is this important?
The recorded webinar provides information and resources regarding the practical and legal aspects of prescribing and supplying medicines for end-of-life care.
The webinar outlines the establishment of a local evidence-based core medicines list to improve timely access to palliative care medicines for patients. The presenters also consider non-pharmacological options and referral pathways to support end-of-life care.
RACGP CPD points are available for General Practitioners.
Learning Objectives
Upon completion of this webinar, general practitioners should be able to:
- Explain the benefits of anticipatory medicines in end-of-life care.
- Discuss the legal and practical aspects of anticipatory prescribing and supplying anticipatory medicines
- Recall the localised core medicines list for end-of-life care.
- Locate referral pathways to support end-of-life care.
- Identify non-pharmacological treatment options for end-of-life care
How to access the webinar?
The webinar is accessible via Zoom.
Instructions:
- Click here to be directed to the webinar
- Enter the webinar password: $ZniZ9N=
- Once you have register yourself, you will be able to watch the webinar.
- Upon completion of the PCAM Anticipatory Medications webinar in its entirety, you will receive an email with your certificate of attendance and your hours will be lodged with the RACGP by the end of the month by EMPHN.
Map of participating community pharmacies
The map below shows the location of participating local community pharmacies that have agreed to stock the CML to facilitate timely access to palliative care medicines. Although listed pharmacies have agreed to stock the above medicines, we suggest calling ahead of time to ensure stock availability. Please note, that the below list of participating pharmacies is not exhaustive, and new pharmacies are onboarded weekly.
Additional resources
- Safer Care Vic Anticipatory Medications Guidelines
- Palliative Care Advice Service, Phone: 1800 360 000, 7 am – 10 pm, seven days per week
- EMPHN Palliative Care page
Are you a pharmacist interested in supporting palliative care?
Visit the Pharmaceutical Society of Australia to learn more.