See Overleaf for Guidance on Pre-Printed Kardex

PRESCRIPTION KARDEX

‘When Required Medicines’ for patients with anticipated palliative needs
Remember to prescribe appropriate analgesia for breakthrough pain on this kardex
Complete details below or attach addressograph label
Patient Name / Address / CHI / Practice
Medicine / Dose / Frequency / Recommended Guide of Maximum number of doses before referral to Doctor / Route / Signed / Date / Discontinued / Date
For Nausea and Vomiting
Levomepromazine / 5mg / 2 hourly / 2 / subcutaneous
Cyclizine / 50mg / 8 hourly / 2 / subcutaneous
For anxiety / restlessness
Midazolam / 2mg / hourly / 3 / subcutaneous
For respiratory secretions
HyoscineButylbromide / 20mg / 2 hourly / 3 / subcutaneous
For Pain / Breathlessness
Morphine Sulphate
1/6 of current 24hour dose
(When converting from oral to subcut divide by 2-see overleaf) / subcutaneous
Oxycodone
1/6 of current 24hour dose
(When converting from oral to subcut divide by 2 – see overleaf) / subcutaneous

See overleaf for guidance on pre-printed kardex

Appendix 6 - continued

Guidance on the use of the pre-printed Prescription Kardex.

This document allows consistent anticipatory prescribing of some of the medicines that may be required by patients with palliative care needs. It complements the use of the ‘Just in Case’ boxes supplied to some patients and reflects the medicines included within these boxes. The medicines chosen are based on current guidance as adopted by NHS Fife. The prescription kardex will sit in the patient’s care plan and allow administration of the medicines prescribed should they be needed.

It is anticipated that the biggest benefit of the pro-forma will be during the out-of-hours period and should help out-of-hours services facilitate management of a patient’s condition until usual care can be continued.

If any of the medicines are identified as being suitable for a patient the prescriber should sign and date the prescription kardex. If any of the medicines are unsuitable for a patient, the prescribing GP should not sign or date the kardex. Only medicines that have been signed and dated by the prescriber can be administered by community nursing staff. If a patient’s condition changes making a previously prescribed medicine no longer suitable for the patient, the prescriber should sign and date the shaded discontinued boxes and place a score line through the order.

Because the dose of an analgesic will be dependent both on the previous dose and preparation the patient has been receiving, the prescriber is asked to add this ‘when required - PRN’ dose on the prescription themselves. Suitable PRN schedules are detailed below as a guide. The one sixth (1/6) rule applies in that the PRN dose should be calculated as one sixth of the patients regular dose, (to convert from oral morphine to subcutaneous morphine divide by 2).

If a patient’s regular dose of analgesia changes the breakthrough dose of analgesic should be reviewed and reflect this dose change. When an analgesic prescription is no longer appropriate the prescriber should sign and date the shaded discontinued boxes and place a score line through the order.

If the prescription kardex is used for a patient this should be included in the ‘Special Notes’ Alert supplied to NHS24 / PCES or the electronic Palliative Care Summary (ePCS) when available.

Quick Guide to Breakthrough Dosing of Analgesia based on a patient’s regular analgesic intake:

Regular Prescription / Corresponding Subcutaneous Breakthrough / Conversion factors from oral to subcutaneous
Morphine Sulphate MR 30mg bdPO / Morphine Sulphate InjSC 5mg / Morphine sulphate 10mg PO = Morphine sulphate SC 5mg
Oxycodone MR 30mg bdPO / OxycodoneInjSC 5mg / Oxycodone 10mg PO = OxycodoneSC 5mg

For further information on dose equivalence see Scottish Palliative Care Guidelines. 2015. Available at:

Date Reviewed: December 2015

Date Reviewed: December 2015