How do I know when to give breakthrough medicines at home?
Give breakthrough medicine only when the person's written plan says it is needed for the symptom you are seeing.
Give breakthrough medicine only when the person's written plan says it is needed for the symptom you are seeing. If the plan says morphine is for pain or breathlessness, do not use it for a different symptom unless the palliative care team tells you to.
When you are unsure, call the palliative care team, nurse, GP, pharmacist or after-hours number before giving the dose. You are not expected to guess.
General information: This page gives general information for people in Australia. It cannot tell you exactly what is happening in one person's situation. If you have concerns about a symptom, medicine, treatment decision or change in someone's condition, contact their doctor, palliative care team, nurse or other treating health professional.
Start with the written plan
A good home plan should name the symptom, the medicine, the dose, the route, how often it can be given, and when to call for help. Keep it beside the medicines. Use it each time, even if you think you remember.
Breakthrough symptoms can include pain, breathlessness, nausea, vomiting, agitation, anxiety or noisy secretions. Different medicines treat different symptoms. Giving the wrong medicine may not help and can cause harm.
Look for signs of the symptom
If the person can speak, ask what they feel. Pain may be described as aching, burning, pressure, cramps or soreness during movement. Breathlessness may feel like air hunger, tightness or panic.
If the person cannot speak, look for changes such as grimacing, moaning, guarding, restlessness, tense muscles, pulling away during care, faster breathing, frightened facial expression or repeated attempts to sit up. These signs can have more than one cause, so use the plan and call if you are unsure.
Check what else might help
Some symptoms need medicine, but comfort measures can still help. Repositioning, mouth care, a cool fan to the face, reducing noise, gentle reassurance, loosening tight bedding, or slowing personal care may reduce distress.
Do not delay medicine for a severe symptom if the written plan says to give it. Breakthrough medicine works best when used early enough, not only after the person is highly distressed.
Record every dose
Write down the time, medicine, dose, symptom and effect. This helps the team decide whether the regular plan needs changing. caring@home resources include medicine diaries for this reason.
If the person needs repeated breakthrough doses, or the dose does not seem to last, tell the team. It may mean the background medicine needs review or a new problem needs assessment.
When not to give it without advice
Call before giving breakthrough medicine if:
- the symptom is not listed in the plan
- the medicine label and plan do not match
- you are unsure when the last dose was given
- the person is much sleepier than usual
- the person has new confusion, twitching or jerking
- you think a dose may already have been given by someone else
- the medicine looks different from what you expected
If the person has severe distress and you cannot reach anyone, use the emergency instructions in the plan. If there is no plan and the situation feels urgent, seek urgent medical advice.
When to get help now
Call the palliative care team or after-hours number if a symptom is new, worsening, frightening, or not settling after the written plan has been followed.
Call 000 if the person is not breathing, cannot be woken, has a possible overdose, severe bleeding, choking, a serious fall, or another life-threatening emergency.
You may also want to read
- Can I give breakthrough morphine or other medicines myself?
- What do we do tonight if they become breathless, agitated or in pain?
- What do I do if something frightening happens at 2 am?
- When should I call the palliative care team?