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Syringe Driver Commencement in Palliative Care :Comprehensive Triage Questionnaire

Syringe drivers play a vital role in palliative care, delivering continuous subcutaneous medication to manage distressing symptoms such as pain, nausea, breathlessness, and agitation. This essential tool supports effective symptom control, particularly in the community setting, where timely and accurate assessment is critical for addressing the complex needs of patients.


The Comprehensive Triage Questionnaire for syringe driver initiation has been specifically designed to streamline the evaluation process. By systematically addressing key factors—clinical urgency, logistical considerations, and patient-specific needs—this tool ensures that decisions are both patient-centered and resource-conscious.


Syringe Driver Triage Questionnaire

Syringe Driver Triage Questionnaire



1. Patient Information

1. What is the patient’s name?
2. What is the patient’s age?
3. What is the patient’s primary diagnosis?
4. Where is the patient currently located?
5. Who is the requesting district nurse?

Name:

Contact details:


2. Clinical Assessment

6. What symptoms is the patient experiencing?
7. Rate the severity of symptoms using a validated tool:
8. What medications are currently prescribed?
9. Are the current medications effective?
10. Has there been a recent change in the patient’s condition?


3. Syringe Driver...

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