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Nabilone now a controlled drug

22nd April 2010

Further to a change in UK legislation, nabilone is now classified as a Schedule 2 controlled drug under the Misuse of Drugs Regulations 2001.

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Annual evidence update on pain

22nd April 2010

The UK NHS Evidence supportive and palliative care section (formerly National Library for Health) has produced the 4th annual update of the evidence on pain in supportive and palliative care.

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Guidance on implementing end of life pathway

22nd April 2010

The NHS National End of Life Care programme, in conjunction with My Home Life, has published a series of fact sheets entitled "route to success resources" to support the implementation of the end of life pathway. They can be downloaded from the website link below.

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NICE guideline for neuropathic pain

20th April 2010

The UK National Institute for Health and Clinical Excellence (NICE) has published a clinical guideline on the pharmacological management of neuropathic pain in adults in non-specialist settings (CG96). This updates and replaces recommendations on the drug treatment of painful diabetic neuropathy in previous NICE clinical guidelines (CG15 and CG87).

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Guidance on care planning and decisions made in advance

20th April 2010

The NHS National End of Life Care programme has published a guide providing information on the difference between care planning and decisions made in advance. It sets out the key aspects of general care planning, advance care planning/advance statements, Advance Decisions to Refuse Treatment (ADRT) and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions and can be downloaded from the link below.
The End of Life Care programme has also published a holistic common assessment guide of supportive and palliative care needs for adults requiring end of life care, which can also be downloaded from the link below.

Care planning and advance decisions
Holistic common assessment guide

Personal resuscitation plans for children

20th April 2010

The Association for Children's palliative care (ACT) has produced model resuscitation plans for children and young people in palliative care. They can be downloaded from the link below.

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EAPC white paper

20th April 2010

The European Association for Palliative Care (EAPC) has published a White paper on standards and norms for hospice and palliative care. The paper covers definitions and terminology of palliative and hospice care, common values and philosophy of palliative care, levels of care, patient groups, needs assessment and requirements for different types of services and settings.

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BNF significant changes

2nd April 2010

The new BNF 59 is now available online and contains significant changes as below:
• Appendices 2–5 removed
The information in the previous appendices on renal impairment, hepatic impairment, pregnancy and breastfeeding has been removed. The general information on these topics is now located in the guidance on prescribing section, with the specific information on dosing now located in the individual drug monographs.
• Renal impairment
The BNF is now using estimated Glomerular Filtration Rate (eGFR) Modification of Diet in Renal Disease (MDRD) formula to define renal function, instead of using creatinine clearance as a surrogate for glomerular filtration rate (GFR). This change was made in BNF58, however, in terms of dosage adjustment most individual drug monographs now contain information based on the eGFR rather than creatinine clearance.
The BNF recommends that although the two measures of renal function are not interchangeable, in practice, for most drugs and for most patients (over 18 years) of average build and height, eGFR (MDRD formula) can be used to determine dosage adjustments in place of creatinine clearance.
However, for patients at extremes of weight e.g. BMI <18.5Kg/m² (which may include some palliative care patients) either absolute GFR (which can be calculated from eGFR using body surface area) or creatinine clearance (using ideal body weight) should be used as the measure of renal function on which to adjust doses for drugs in renal failure. Creatinine clearance should also still be used for adjusting doses for toxic drugs.
For more information see the principles of dose adjustment in renal impairment found within the guidance on prescribing section in the BNF and also the guidance on presribing in renal impairment section in PCF3 (see below).
• Equivalent doses of morphine sulphate and diamorphine hydrochloride table
The table showing equivalent doses of morphine sulphate and diamorphine hydrochloride in the prescribing in palliative care section has been revised to improve clarity. The updated version now shows equivalent doses of morphine sulphate and diamorphine hydrochloride over 24h.

BNF changes section (registration required to access BNF content)
PCF3 guidance on prescribing in renal impairment in palliative care patients