Communication
Changes to the Four Core Just in Case drugs
Further to our communication early in the year we are writing to let you know the next steps in the
planned change to the 4 core drugs end of life drugs.
 The SPAR administration booklet has been revised and updated with additional guidance around
medication to use.
 Patient information leaflet has been rewritten and expanded to include instructions on the safe
disposal of the medication when no longer needed
 The number of vials of each medication to be issued in a “just in case” sealed tamper proof bag has
been reduced to 5 vials other than water for injection that remains at 10 vials
 A risk assessment form has been introduced for use by a caring team when there are concerns
about anticipatory medication being left in a patient’s home “just in case”
Two events are being put on at Trinity Hospice to support the transition
 Wednesday 16th September 2015
Open to all medical professionals and pharmacists on the Fylde Coast 18.00 – 20.30
 Tuesday 29th September 2015
Open to all health and social care staff on the Fylde Coast 14.00-17.00
At these events you will be able to see the revised SPAR booklet, updated patient information leaflet and
receive information about the next steps as well as updates on other projects around palliative and end of
life care including hospice at home, DNACPR etc
The changeover from diamorphine to morphine will start on Monday 5th October 2015.
From the 5th October staff will have the chance to familiarise themselves with the new SPAR booklet,
patient information leaflet and risk assessment form, which we will be available from
 Specialist Palliative Care team members across both hospital and community,
 Kathryn Smith, end of life Clinical lead for the Fylde Coast
 Janet Purdie and VIV Trott - Six Steps Facilitators for nursing homes
 Andrew Dickman- Consultant Pharmacist, Blackpool Teaching Hospitals
From mid-October (date to be confirmed) supplies of the new SPAR booklet will be available to order
From the 9th November
 all new patients prescribed just in case drugs must have a new SPAR booklet completed using
morphine and not diamorphine
 For patients who are stable and not imminently dying with just in case drugs in situ, when such
patients are reviewed in the community their SPAR booklet should be rewritten onto a new SPAR
booklet and a new just in case bag issued with morphine not diamorphine
 For patients who are unstable and / or imminently dying a clinical decision needs to be made about
the risk of continuing with the old SPAR booklet and diamorphine.
 It is hoped that this will not be onerous for most practices.
After 31st December 2015 the old SPAR booklet will no longer be a valid authorisation document or
administration record for community staff.
If you have any concerns or require additional clarification please speak to your line manager or email Dr
Salt on dr.salt@trinityhospice.co.uk
Adam Janjua
Chair of the Fylde Coast End
Life Strategy Group
Susan Salt
Medical Director Trinity Hospice