Summary of Key Points
Palliative care services strive to support patients to live and to die within their setting of choice, usually home, with optimal symptom control and with a pattern of care that is also supportive of lay caregivers. The likelihood of patients remaining symptomatically well managed at home usually depends upon input from lay caregivers who may be required to administer subcutaneous medications. Bereaved carers report their ability to provide subcutaneous injections adds value to patient care; nonetheless many report the need for education and resources to assist them to confidently manage this aspect of their caregiving role. 
The purpose of this Australian Government Department of Health and Ageing (DoHA) funded Caring Safely at Home (CSAH) project was to enhance the ability of lay caregivers to manage subcutaneous medications thereby assisting palliative patients access to timely symptom management.
The CSAH project produced a resource and education package, designed to be delivered by clinicians to lay caregivers. The package has been evaluated as improving caregivers’ capacity and confidence to deliver subcutaneous medications - important factors for them when supporting a palliative patient to be cared for at home.
In 2009, the Brisbane South Palliative Care Collaborative (BSPCC) in partnership with the Centre for Palliative Care Research and Education (CPCRE) and Blue Care under the DoHA Supporting Carers of People Requiring Palliative Care at Home initiative developed, piloted and evaluated an education and resource package designed for lay caregivers who are required to administer subcutaneous injections to palliative patients for symptom management in the home setting.
A suite of resources was developed by a team of palliative care clinical, academic and research professionals to support the delivery of consistent information within a standardised educational framework.
Central to the framework is a time effective one-on-one educational session delivered to lay caregivers by registered nurses or doctors.
The educational and resource package is compliant with relevant statutory Queensland requirements and safe medicine practices.
Resources for caregivers
- Illustrated step-by-step guides. These guides provide a simple structured approach to the preparation and administration of subcutaneous injections
- A practice demonstration kit (428kb pdf) that includes a cannula and other equipment involved with the preparation and delivery of subcutaneous injections
- Colour coded medication labels (32kb pdf) for labelling prepared syringes. The colour coding (92kb pdf) follows the Australian and New Zealand Standard – User-applied labels for use on syringes containing drugs used during anaesthesia 2001
- A fridge magnet (85kb pdf) colour coded to help the clinician or caregiver match the relevant medications with symptoms.
- A daily diary (877kb pdf) to document aspects of medication administration
- A video “Giving a Breakthrough Subcutaneous Injection: A guide for lay carers”. This video demonstrates aspects of subcutaneous medication preparation and administration (via a cannula), safe storage and disposal of medications.
- A booklet “Subcutaneous Medication and Palliative Care: A guide for caregivers”. (3.51MB pdf) This booklet covers topics such as frequently asked questions, importance of symptom control, management of common palliative symptoms, commonly used subcutaneous medications and injecting processes
Resources for clinicians
A palliative patient’s preference to be cared for at home or for a home death is often reliant upon a lay caregiver being able to confidently and appropriately provide symptom relief. Such provision can require subcutaneous medication management. The CSAH project successfully developed, implemented and evaluated a standardised education and resource package designed to improve the capacity and confidence of lay caregivers to manage subcutaneous medications.
Best practice guidelines
Prof Liz Reymond MBBS (Hons) FRACGP FAChPM PhD
Ms Sue Healy RN Ba HSc
Ms Fiona Israel RN MCouns
Dr Margaret Charles PhD, MAPS
Brisbane South Palliative Care Collaborative firstname.lastname@example.org