Palliative Care Access to Core Medicines (PCAM)
The Palliative Care Access to Core Medicines (PCAM) project aims to support palliative care in the community and assists people who wish to die at home through timely access to essential medicines. This minimises suffering associated with emergent end-of-life symptoms.
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Eastern Melbourne PHN (EMPHN), South Eastern Melbourne PHN (SEMPHN) and North Western Melbourne PHN (NWMPHN) are proud to be partnering with The Pharmaceutical Society of Australia (PSA), the peak national organisation for pharmacists working in all sectors to deliver this project.
Core Medicine List Information
The Core Medicines List (CML) includes the medicines endorsed by the Australian and New Zealand Society for Palliative Medicines for use in community-based palliative patients and considered the core palliative care medicine lists published in other states.
This list was established first for the NWMPHN region through consultation with GPs, Pharmacists, and local palliative care providers. Utilisation of the existing core medicines list in EMPHN and SEMPHN regions ensures consistency across metropolitan Melbourne.
The purpose of this is to assist community pharmacies to anticipate medicines most likely to be prescribed, and to allow prescribers to anticipate which medicines are most likely to be available for rapid supply in community pharmacies within the EMPHN catchment.
| Medicine category | First Line medicines | Minimum quantity to stock | Indication/s for usein terminal phase patients |
|---|---|---|---|
| Anxiolytic | Clonazepam 2.5mg/mL (0.1mg/drop) Oral Liquid Midazolam 5mg/mL Injection (if an injection is required or preferred) | 10 mL bottle 5 or 10 ampoules | Agitation associated with delirium Anxiety associated with dyspnoea |
| Antipsychotic | Haloperidol 5mg/mL Injection | 10 ampoules | Agitation, nausea, vomiting |
| Anticholinergic | Hyoscine butylbromide 20mg/mL Injection | 5 ampoules | Respiratory tract secretions Noisy breathing |
| Antiemetic | Metoclopramide 10mg/2mL Injection | 10 ampoules | Nausea, vomiting |
| Analgesic (high potency opioid) | Morphine (sulfate or hydrochlordie) 10mg/mL and/or 30mg/mL Injection | 5 ampoules | Dyspnoea, pain |
The National Core Community Palliative Care Medicines List was released during National Palliative Care Week (May 19-25, 2024). This list, developed by caring@home in collaboration with PSA, aims to provide a core medicines list applicable across all Australian states and territories, similar to the PCAM Project but on a national scale. The PCAM Project CML includes the same medicines as the National Core Community Palliative Care Medicines List, with the addition of Metoclopramide 10mg/2mL Injection.
There may be some supply issues with metoclopramide injection, including the discontinuation of PBS-listed Maxolon. Alternative brands of metoclopramide have not yet been listed on the PBS, however as their cost is not prohibitively expensive, the recommendation to prescribers is to continue to prescribe metoclopramide as first line antiemetic medicine. Haloperidol injection is also an appropriate alternative therapy for nausea and vomiting in palliative care while these supply issues continue, however is more sedating.
Community pharmacies are encouraged to stock these first-line medicines as this is the recommended list that will be communicated in the region. Additional medicines may be stocked dependent upon local prescribing preferences and/or stock availability.
This list does not restrict which medicines can be prescribed for individual palliative patients.
This recorded webinar on Medicines in the last days of Life will equip general practitioners, community pharmacists, and other health professionals with knowledge about anticipatory medicines and medication management for end-of-life care.
Why is this important?
The recorded webinar provides information and resources regarding the practical and legal aspects of prescribing and supplying medicines for end-of-life care. 
The webinar outlines the establishment of a local evidence-based core medicines list to improve timely access to palliative care medicines for patients. The presenters also consider non-pharmacological options and referral pathways to support end-of-life care.
RACGP CPD points are available for general practitioners.
Learning Objectives
Upon completion of this webinar, general practitioners should be able to:
- Explain the benefits of anticipatory medicines in end-of-life care.
- Discuss the legal and practical aspects of anticipatory prescribing and supplying anticipatory medicines
- Recall the localised core medicines list for end-of-life care.
- Locate referral pathways to support end-of-life care.
- Identify non-pharmacological treatment options for end-of-life care
How to access the webinar?
The webinar is accessible via Zoom.
Instructions:
- Click here to be directed to the webinar
- Once you have registered yourself, you will be able to enter the password below and watch the webinar.
- Enter the webinar password: MLDL@EMPHN1
- Upon completion of the PCAM Anticipatory Medications webinar in its entirety, you will receive an email with your certificate of attendance and your hours will be lodged with the RACGP by the end of the month by EMPHN.
Map of participating community pharmacies
The map below shows the location of participating local community pharmacies that have agreed to stock the CML to facilitate timely access to palliative care medicines. Although listed pharmacies have agreed to stock the above medicines, we suggest calling ahead of time to ensure stock availability. Please note, that the below list of participating pharmacies is not exhaustive, and new pharmacies are onboarded weekly.
Additional resources
Safer Care Vic Anticipatory Medications Guidelines
Palliative Care Advice Service
Phone: 1800 360 000, 7am – 10pm, seven days per week.Are you a pharmacist interested in supporting palliative care?
