Palliative patients who may benefit from intranasal delivery of symptomatic drugs: a two-center observational study evaluated the administration of morphine and dexamethasone in Polish hospices

INTRODUCTION

Patients receiving hospice care at the end of life often suffer from a variety of ailments. They may need medication to alleviate symptoms for the rest of their lives. The most common and recommended way to take opioids and steroids is orally. Less frequently, the subcutaneous or intravenous routes are used. The intranasal route is a relatively uncommon but interesting alternative for administering drugs.

AIM

The study aims to identify hospice patients who may benefit from changing the standard opioid and steroid administration route to intranasal delivery.

MATERIAL AND METHODS

The electronic medical records of all home and inpatient hospice patients (both rural and urban) were analyzed between February and April 2024. The study focused on the magnitude and type of problems associated with taking medications via standard routes and assessed the potential for changing to an intranasal route of administration.

RESULTS

Patients who were prescribed morphine, dexamethasone, or both during co-administration were included in the analysis. Of the 282 patients receiving hospice care over the study period, 95 met the inclusion criteria (33.7%). According to the researcher's original survey 87% of patients experienced issues with taking medications through the standard route. Among the problems related to oral medicines, consciousness disorders were the most significant at 66%. For subcutaneous administration, the main issues were reluctance to inject at 19% and lack of cooperation from caregivers at 20%.

CONCLUSION

The profile of a hospice patient who may benefit from intranasal administration of symptomatic drugs includes patients with impaired consciousness, aversion to subcutaneous injections, and reluctance to administer injections by caregivers.

Subcutaneous fluid and drug delivery: safe, efficient and inexpensive

Patients with difficult venous access or oral intolerance and clinical situations with inadequate response to oral therapy have generated the need for alternative routes of delivery for drugs and fluids.

The purpose of this study was to conduct a systematic review examining the evidence for subcutaneous (SC) administration of drugs and/or fluids.

We used a broad search strategy using electronic databases CINAHL, EMBASE, PubMed and Cochrane library, key terms and ‘Medical Subject Headings’ (MeSH) such as ‘subcutaneous route’, ‘hypodermoclysis’ and the name/group of the most used drugs via this route (e.g. ‘ketorolac, morphine, ceftriaxone’, ‘analgesics, opioids, antibiotics’).

We conclude that the SC route is an effective alternative for rehydration in patients with mild–moderate dehydration and offers a number of potential advantages in appropriately selected scenarios. Experience of administering drugs by this route suggests that it is well tolerated and is associated with minimal side-effects.

Family members' perceptions and expectations of the use of syringe drivers: a South African study

AIM

This study aimed to explore and gain insight into the perceptions and expectations of family members of terminally ill patients pertaining to the use of syringe drivers.

BACKGROUND

There is a lack of research regarding the use of syringe drivers in Africa and, more specifically, South Africa. However, syringe drivers have been in use for around two decades in some South African settings. Some family members' ambivalence about the use of syringe drivers and the lack of research prompted this study.

METHOD

A qualitative exploratory research design was used. Data was collected using semi-structured interviews, diaries, observation, and documentation. Thematic analysis and coding were used to analyse the data.

RESULTS

Four main themes were identified: the rationale for the need for the syringe driver, positive perceptions pertaining to the use of the syringe driver, negative perceptions, and concerns/anxieties. The study also highlighted the challenges of drug addiction in some households when caring for terminally ill patients.

CONCLUSION

The need for more continuous education and written information and support for immediate and extended family members was evident.