In the last days of life it is likely that you will no longer be able to manage oral medication. Regular medication that you may have been taking for years should have already been stopped.
By now you should only be receiving medication that helps to control any symptoms you may have. Unless you are in a hospital or hospice where medication is readily available, your district nurse, specialist nurse or GP will organise a 'just in case' box of medication. This is to have on stand by so it is available at short notice if you need it. The medication in the box is prescribed for you and should never be given to anyone else. Usually the box will contain medication for pain, vomiting, agitation, noisy breathing and severe anxiety.
If you can't swallow tablets you may be able to manage liquid medication. Many medicines are available as soluble tablets or as a liquid. If you are too weak to manage liquid medication or if you are vomiting, medication may be given by injection or through patches stuck to the skin.
It's not always easy to get the most effective combination of medicines and doses to control your symptoms right first time. Often it's a case of trying something then reviewing how it's worked and making changes if necessary.
The type of medicine, the dose and frequency and way it's given is what's called your drug regime. As part of your drug regime, especially for pain control, you may have regular medication and 'top-up' medication that you take if required – for example if the pain gets worse between regular doses, before painful dressing changes or while waiting for patches to 'kick in'.
Giving medication through a patch stuck to the skin can be very effective and long lasting. The patch needs to be changed every few days depending on the type of medication it contains. The medication is released slowly so the first patch or a new patch dose can take a few days to get into your system. Sometimes 'top-up' injections or liquid are needed to help control symptoms before the patch 'kicks in'.
Occasionally the adhesive in the patch can cause mild inflammation of the skin.
Injected medication can be given in a variety of ways:
- Injected under the skin – this is called a subcutaneous injection
- Injected into the muscle – this is called an intra-muscular injection
- By infusion into a vein – the medication is mixed with a bag of sterile salt solution and dripped into a vein usually in your arm through a small plastic tube. The rate of flow of the solution is controlled by a pump.
- By slow infusion under the skin using a syringe driver
The medication is mixed with a small amount of sterile salt solution or sterile water in a syringe. The syringe is fixed to a small battery operated device that delivers tiny amounts of the medication through a thin flexible plastic tube and needle inserted under the skin. This is called a syringe driver. It is a common way of giving strong pain killers and other medication at the end of life.
The needle is inserted under the skin, usually in the upper arm, thigh, stomach or chest and is held in place with a small, clear dressing.
There is usually a small flashing light that tells you that the driver is switched on and working. You may hear a faint 'whirring' sound from the motor that drives the syringe to deliver the medication.
The syringe normally needs to be changed once a day. A District Nurse usually does this but some people monitor their own syringe drivers.
Carers can help by:
- looking out for signs of redness or discomfort where the needle has been inserted
- remembering that 'top up' injections may be necessary until the correct drug regime is found
- making sure the driver and needle are kept dry
It is possible to have a bath with a syringe driver attached as long as you are careful.