gms | German Medical Science

19. Deutscher Kongress für Versorgungsforschung

Deutsches Netzwerk Versorgungsforschung e. V.

30.09. - 01.10.2020, digital

‘Palliative syringe driver’ – continuous infusions of sedatives and/or opioids in end of life care on hospital wards. A mixed methods study

Meeting Abstract

  • Sophie Meesters - LMU Klinikum, Klinik und Poliklinik für Palliativmedizin, München, Deutschland
  • Bettina Grüne - LMU Klinikum, Klinik und Poliklinik für Palliativmedizin, München, Deutschland
  • Claudia Bausewein - LMU Klinikum, Klinik und Poliklinik für Palliativmedizin, München, Deutschland
  • Eva Schildmann - LMU Klinikum, Klinik und Poliklinik für Palliativmedizin, München, Deutschland

19. Deutscher Kongress für Versorgungsforschung (DKVF). sine loco [digital], 30.09.-01.10.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. Doc20dkvf365

doi: 10.3205/20dkvf365, urn:nbn:de:0183-20dkvf3654

Published: September 25, 2020

© 2020 Meesters et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Background and current state of (inter)national research: Continuous infusions (CIs) of sedatives and/or opioids are frequently used in specialist palliative care (SPC) at the end of life. While this seems to be safe for symptom control in SPC, available data indicate challenges in non-SPC settings. Yet, little is known about this practice in end of life care on general hospital wards.

Questions and objectives: To assess the use of CIs of sedatives and/or opioids during the last week of life on general hospital wards and associated challenges as perceived by healthcare professionals.

Methods or hypothesis: Sequential mixed methods design in five German hospital departments: haematology/oncology (n=2), neurology, geriatrics, gynaecology. A retrospective cohort study of 517 patients who died from 1/2015 to 12/2017, using medical records, was followed by 25 semi-structured qualitative interviews with physicians and nurses. Recorded sedatives were those recommended in guidelines for “palliative sedation”: benzodiazepines, levomepromazine, haloperidol (≥ 5 mg/day) and propofol. Exploratory statistical analysis (R 3.6.1.) and Framework analysis (MAXQDA 2018.2).

Results: During the last week of life, 359/517 deceased patients (69%) received CIs of a sedative and/or opioid (CIs). 222/359 (62%) received sedatives as well as opioids, which were started on the same day for 153/222 (69%) patients (combined CIs). Interviewees reported that combined CIs are a kind of standard procedure for patients at the end of life. One interviewee assumed that the label ‘palliative’ may prompt professionals to start CIs earlier and in higher doses. In 44 cases, combined CIs were termed as ‘palliative concept’ or ‘palliative syringe driver’ in the medical records. However, most interviewees emphasized that drugs and doses are individually adapted according to the patient’s symptoms. For 92/359 (26%) patients receiving CIs, the indication was missing. One nurse argued that combined CIs cover a wide range of symptoms, which are often hard to differentiate in dying patients. Some nurses experienced concerns or hesitations among physicians regarding the handling of CIs. Both nurses and physicians perceived a palliative care team as an important support for adequate practice. In 212/359 (59%) patients receiving CIs, a palliative care team was involved.

Discussion: The results demonstrate that simultaneously started combined CIs are common practice on general hospital wards. Their labelling as ‘palliative syringe driver’ or ‘palliative concept’ in the medical records and interviewees’ reports suggest that these combined CIs are sometimes seen as ‘standard procedure’ in the care of the dying. The combination of missing indications for CIs, concerns regarding their handling and the perception of “standard procedures” in this highly individual care situation emphasizes the need for further exploration and support for professionals to ensure high quality of care.

Practical Implications: The beginning of the dying process should not automatically prompt the initiation of combined CIs. A thorough assessment of symptoms and individual decisions are paramount. However, concerns regarding CIs should not lead to avoiding or postponing them.