Just in Case Bags (JICB) formalise anticipatory prescribing towards the end of life when a clinical deterioration is anticipated but the patient does not yet need as required subcutaneous injections or a syringe pump for current symptom control.

The availability of anticipatory prescribing can minimise distress to the patient and their family by having such medications readily accessible for when they might be needed.

Once the patient has a syringe pump in situ, there is no longer a need for JICB and “as required” subcutaneous medication should be prescribed on the relevant syringe pump prescription form.

The prescriber should ensure that all relevant agencies are informed that the JICB is within the care setting; this can be achieved via the Electronic Patient Care Co-ordination System (EPaCCS).

Please refer to local Just in Case information:

• For West Devon patients please contact: St Luke's Hospice Tel: 01752 964200 Email: community@stlukes-hospice.org.uk
• For South Devon patients please contact Rowcroft Hospice Tel: 01803 210800
• For North and East Cornwall patients please contact the Specialist Palliative Care Team Tel: 01208 251300

Refer to 16.1 Palliative care services: contact details, resources for further information.

Suggested medication that could be included in standard Just in Case Bags for patients without COVID-19

• 2 x ampoules of morphine sulfate10mg/1ml for pain or breathlessness at a dose of 2.5 to 5mg when required s/c*
• 2 x ampoules of levomepromazine 25mg/mL for nausea and vomiting
• 3 x ampoules midazolam 10mg/2mL for restlessness, anxiety, agitation and breathlessness
• 2 x ampoules of haloperidol 5mg/mL for nausea, hallucinations and agitation
• 3 x ampoules of hyoscine hydrobromide 400 microgram/ml or hyoscine butylbromide 20mg/mL or glycopyrronium 200 micrograms/mL for respiratory tract secretions

*Consider whether patient is opiate naïve or if there is a requirement for high dose for breakthrough pain if on regular opiate.

Authorisations form for administration of Just in Case medications must also be completed by the prescriber.

Please refer to the Care of the dying person section