Carer diary instructions
To assist you in your caring role, this diary plan has been developed specifically to assist you with recording the as-needed subcutaneous medications that are given to the person you are caring for each day.
You should complete a page in this diary each time the person you are caring for experiences a breakthrough symptom that requires as-needed subcutaneous medication, even if you do not administer the medication yourself.
Use a blank piece of A4 paper to complete the information below, or download and print the booklet with the button at the bottom of this page.
Step 1
Write the date (day/month/year) and time that you or the person you are caring for feels that a symptom is developing that is not being controlled by any regular medication or previous doses of as-needed medication.
Tick the box to indicate who noted the symptom developing.
Step 2
Tick the box which best explains the reason you are giving the medication. Sometimes you may need to give different medications, for example one for pain and one for nausea. If so, record each on a separate page.
Step 3
If possible, ask the person how they would rate their symptom on a scale of 0-10, where 0 is no symptom and 10 indicates the worst that symptom can possibly be. If the person is not able to tell you, you can record how bad you think the symptom is in your experience of caring for the person. Record the number for the symptom. This will help you to see later on if the symptom has improved.
Tick the box to show who rated how bad the symptom was, you or the patient.
Step 4
Write the name of the medication each time you give it.
Tick the box to show if you gave the medication or if a healthcare professional (HCP) was called and gave it.
Step 5
Write the dose of the medication each time you give it. Remember to put the number and the units (the letters after the number). You should check this is correct using the chart at the front of your diary before giving the medication.
Step 6
Write the time that the as-needed medication was given.
Step 7
After 30 minutes have passed since the medication was given, check to see if the symptom has improved. Again, if possible, ask the person how they would rate their symptom on a scale of 0-10, where 0 is no symptom and 10 indicates the worst that symptom can possibly be. If the person is not able to tell you, you can record how severe you think the symptom is in your experience of caring for the person. Record the number for the symptom.
Tick the box to show who rated how severe the symptom was. This may be you, the patient or a healthcare professional if one was called.
Remember: Everyone is different and for some people, the as-needed medications can take between 15-30 minutes to work. Allow this time for the medication to work before checking and recording the symptom score for this section of the diary. If you are concerned you can contact your doctor or nurse for further adviceStep 8
When the patient’s symptoms have improved to an acceptable level, tick the box to indicate if this happened within 30 minutes of the medication being given, or if it took longer. If it took longer than 30 minutes, write down the time it took for the symptom to improve to an acceptable level.
Tick the box to show who made the assessment of when the symptom was resolved. This may be you, the patient or a healthcare professional if one was called.
Step 9
If you gave the medication, rate how confident you were in preparing and giving the injection on a scale of 1-10
(1 = not at all confident,
10 = extremely confident).Step 10
Tick the box to indicate if you called a healthcare professional (such as a nurse or out of hours services) to visit you at home as a result of the breakthrough symptom. If so, there is a section at the bottom of the page they should complete.
Step 11
Add any extra comments that might be helpful to you. This can be anything that you might want to remind yourself of later or anything you might want to remember to discuss with the person’s healthcare team.