Identify the right route and form to ensure medications are delivered in the most safe and effective way for each individual patient

Discussion 1

A decision was made to discontinue with oral analgesia due to the increased prevalence of dysphagia. Appropriate medication management for patients with dysphagia is important as achieving optimal pain management via oral formulations can be difficult, and also dangerous due to the increased risk of aspiration and choking (Mc Gillicuddy et al., 2017; Pergolizzi et al., 2014; Wright et al., 2020). Although oral morphine for cancer pain has been found to provide a good level of pain relief it is important to look at the situation holistically, giving careful consideration to what is most appropriate for James given his specific care needs. It is essential to ensure the care, safety and best interests of each individual patient are the main priority at all times (Nursing and Midwifery Council (NMC), 2018), and although the oral route is the widely preferred initial route for analgesia, other routes are suggested if dysphagia occurs (Greater Manchester Health and Social Care Partnership, 2019; NICE, 2016). The Rights of Medication Administration highlight that the right route and form should be identified to ensure medications are delivered in the most safe and effective way for each individual patient (Elliott and Liu, 2010; Mc Gillicuddy et al., 2017).

As oral analgesia was stopped, alternative interventions were explored to help manage James symptoms and to ensure he was comfortable, as controlling pain is a fundamental element of palliative nursing care (British Medical Association (BMA), 2017; Scarborough and Smith, 2018). Although James was already using fentanyl patches he was still experiencing breakthrough pain. Over time opioid tolerance is adapted as increased exposure to the drug generates changes to the receptors, which ultimately reduce the effectiveness of the drug (Lilley et al., 2014). As the oral route was deemed inappropriate an alternative method of drug administration had to be adopted.