Medicines Management Policy - Dudley Primary Care Trust

21. Syringe Drivers
Please refer to the current ‘Policy for the use of Graseby MS26 Syringe Drivers
in Palliative Care’ compiled by Dudley Macmillan Community Palliative Care
Team. (http://joint.dudley.nhs.uk/cmsextra/documents/cms/191-2008-1-21-
5949772.pdf)
Patients/clients may receive subcutaneous infusions of medicines such as
morphine, diamorphine, heparin and insulin via an electronically powered
syringe driver. Macmillan Nurses and District Nurses may operate syringe
drivers provided that they have received training and are competent as laid
down in the current syringe driver policy.
21.1 Administration must be carried out in accordance with guidance in section 9 of
the MMP.
21.2 When a dose increase is required outside of the patient/client’s drug
regimen/ceiling dose, the doctor/competent independent prescriber is expected
to attend and re-assess the patient/client and give written instructions on dose
adjustments. In exceptional circumstances a verbal instruction to adjust a dose
can be accepted and the procedure in section 12 followed.
In very exceptional circumstances it is permissible for a verbal instruction to be
taken to increase the dose of a syringe driver containing a controlled drug
providing that it is at the direction of the patient/client’s doctor/competent
independent prescriber and it is in the patient/client’s best interest to do so. A
community nurse acting on such a verbal instruction should be aware of
possible consequences resulting from such action and the importance of fully
documenting the incident as described in section 10. The doctor/competent
independent prescriber must provide written confirmation of the dosage
alteration as soon as practicable but within 24 hours in all circumstances.
An additive label must be completed and attached to the syringe ensuring that
graduation markings are obscured, in order to ensure that the dose is
measured in mm not ml as per ‘West Midlands Palliative Care Guidelines.’
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