Background

The COVID-19 pandemic is expected to put pressure on healthcare systems across Scotland. It is important that, despite this, all people who are approaching the end of life continue to have good symptom management.

In addition to the people who are in the last weeks or days of life at present, it is expected that some people who are in the last months of life or are very frail may become infected with COVID-19, and these people may or may not have the reserve to recover from this illness. It is important that these people have access to appropriate care for potentially reversible conditions, but also that their symptoms are managed as far as possible.

This guideline aims to support professionals who are already skilled in providing generalist palliative care in identifying alternatives to usual drugs and routes of administration, when usual drugs or syringe drivers are not available. We recognise that the vast majority of palliative care happens in the community, in people’s homes, in care homes, and in hospital, and we wish to support those who provide excellent care for people to continue to do so with confidence.

In addition to managing symptoms with medications, it is important to address reversible causes of deterioration and to use non-pharmacological methods to help symptoms where possible. Further advice is available here.

Note that the use of fans for the treatment of breathlessness is not recommended during the COVID-19 outbreak. Portable fans used in clinical areas have been linked to cross infection in health and social care facilities, although there is no strong evidence yet. Portable fans are not recommended for use during outbreaks of infection or when a patient is known or suspected to have an infectious agent.

As the situation changes, there may be changing availability of drugs. We aim to keep these guidelines updated in view of this.