Anticipatory syringe drivers: a step too far

A recent report on the use of anticipatory syringe drivers continuous subcutaneous delivery of opioids and other medications at the end of life (see https://www. gosportpanel. independent.gov. uk/ media/ documents/ 070618_CCS207_ CCS03183220761_Gosport_Inquiry_ Whole_ Document. Pdf) has led to warnings about the use of it (1). The report states that at least 456 patients died in case opioids had been described and administered in unjustified doses. The reason is not the syringe driver itself, but the way it is used. Browers et al. (1) see the report as ‘a timely warning of the potential dangers of ‘anticipatory syringe drivers’ prescribed in anticipation of future symptoms at the end of life.’ Using new technology often means implicitly a significant change in the way patients are cared for or at least it is seen as a change by patient and family. Therefore, Browers et al. advise – before starting a syringe driver to explore ‘patient and family understanding and wishes, to discuss the goals of treatment, including the possible effects of administered drugs and to advise that drugs given in doses appropriate for symptom control will not hasten death.’

The Gosport Inquiry Report is very detailed, very well documented and it reads as a horror story. It is a lesson for all working in health care. It is not only a lesson for the UK, but for all health care systems.

References

  1. Bowers B, et al. BMJ Supportive & Palliative Care 2019;9:149–150. doi:10.1136/bmjspcare-2018-001728 149 BMJ Support Palliat Care: first published as 10.1136/bmjspcare-2018-001728 on 1 June 2019. Downloaded from http://spcare.bmj.com/ on September 23, 2019 by guest.

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