× NICE uses cookies to make the site better.  Learn more
A-Z
Topics
Latest

Opioids in palliative care overview

history control tooltip

divider handle tooltip

Opioids in palliative care HAI

About

What is covered

This pathway covers safe and effective prescribing of strong opioids for pain relief in adults (18 years and older) with advanced and progressive disease.
The pathway addresses first-line treatment with strong opioids for patients who have been assessed as requiring pain relief at the third level of the World Health Organization pain ladder. It does not cover second-line treatment with strong opioids where a change in strong opioid treatment is required because of inadequate pain control or significant toxicity.
This pathway clarifies the clinical pathway for prescribing strong opioids in palliative care, and will help to improve pain management and patient safety. It is aimed at non-specialist healthcare professionals initiating strong opioids for pain in adults with advanced and progressive disease. However, it is likely to be of relevance to palliative care specialists as well.

Updates

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Updates to this pathway

2 September 2014 Minor maintenance updates.
19 November 2013 Minor maintenance updates.
22 February 2013 Minor maintenance updates.
13 September 2012 Education tool added to pathway.
26 June 2012 Links repaired to audit tools and podcast, and learning resources added to pathway.

Short Text

Safe and effective prescribing of strong opioids for pain in palliative care of adults

What is covered

This pathway covers safe and effective prescribing of strong opioids for pain relief in adults (18 years and older) with advanced and progressive disease.
The pathway addresses first-line treatment with strong opioids for patients who have been assessed as requiring pain relief at the third level of the World Health Organization pain ladder. It does not cover second-line treatment with strong opioids where a change in strong opioid treatment is required because of inadequate pain control or significant toxicity.
This pathway clarifies the clinical pathway for prescribing strong opioids in palliative care, and will help to improve pain management and patient safety. It is aimed at non-specialist healthcare professionals initiating strong opioids for pain in adults with advanced and progressive disease. However, it is likely to be of relevance to palliative care specialists as well.

Sources

NICE guidance

The NICE guidance that was used to create the pathway.
Opioids in palliative care. NICE clinical guideline 140 (2012)

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Commissioning

These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.

Education and learning

NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.

Pathway information

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Updates to this pathway

2 September 2014 Minor maintenance updates.
19 November 2013 Minor maintenance updates.
22 February 2013 Minor maintenance updates.
13 September 2012 Education tool added to pathway.
26 June 2012 Links repaired to audit tools and podcast, and learning resources added to pathway.

Supporting information

Glossary

Background pain is chronic, persistent pain. Breakthrough pain is a transient increase in pain intensity over background pain, typically of rapid onset and intensity, and generally self-limiting with an average duration of 30 minutes.
A dosage form that is intended to release all the active ingredient on administration with no enhanced, delayed or extended release effect.
A rescue dose is the dose of analgesic needed for the relief of breakthrough pain.
Morphine-like drugs (such as diamorphine, fentanyl, oxycodone, buprenorphine). Codeine and dihydrocodeine are weak opioids.
A subcutaneous injection of opioids is given in the fatty layer of tissue just under the skin.
A dosage form that is designed to release a drug at a predetermined rate by maintaining a constant drug level for a specific period of time with minimal side effects.
Medicated adhesive patches that are placed on the skin to deliver a specific dose of medication through the skin into the bloodstream.

Paths in this pathway

Pathway created: June 2012 Last updated: September 2014

© NICE 2014

Recently viewed