10th January 2024

An 80-year-old lady with colorectal cancer has been admitted to the hospice due to right upper quadrant pain related to liver metastasis

An 80-year-old lady with colorectal cancer has been admitted to the hospice due to right upper quadrant pain related to liver metastasis. She is on a syringe driver due to difficulty managing tablets. Dexamethasone is being given by subcutaneous injection at an appropriate dose. She is having morphine 60mg via the syringe driver, with breakthrough given subcutaneously at 10mg. The drug chart shows that she has had 6 PRN doses a day for the last 4 days. On discussion with the nursing staff, they report she has been requesting a dose at 8 a.m. and 8 p.m. to facilitate washing, at 1 p.m. just before she gets out into a chair, and at 5 p.m. before getting back into bed. The PRN dose does help her pain.

How would you change this patient’s opioid regimen?

Select the SINGLE most appropriate option from the list below. Select ONE option only.