Thanks to Catherine Thatcher and Julie Brown, teaching fellows at Sunderland Royal for this scenario
Emma Morrison is a 72 year old lady admitted with severe back and hip pain. She has been feeling generally unwell for 2 months and has a history of ovarian cancer for which she had surgery and follow up chemotherapy 2 years ago.
She has been diagnosed with bony metastases and a DNAR form has been completed.
She is currently prescribed 5 mg of morphine subcutaneous PRN which she has needed every 2-3 hours for the past 24 hours. She has had 60mg in total over 24 hours. Her weight is 52kg. Emma is nil by mouth as she is no longer able to swallow.
This morning the nursing staff reported that Emma is crying in pain when being moved. She is agitated, restless and distressed.
You have been asked to prescribe a subcutaneous infusion for Emma:
Ward E50 Sunderland Royal Hospital
Consultant Dr Wiseman
No known drug allergies
In order to get some prescribing resources out there we intend to publish a series of prescribing problems on the website. The problems will appear at least weekly with the "answers" appearing a couple of days later. We'll use the standard exam stationery available on the LSE, but also available below in case you haven't got access to the LSE.