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Blog articles are provided as informational purposes only and are not intended to constitute medical advice. Medication protocols are subject to patient’s medical provider’s authorization.

 

In hospice and palliative care, we sometimes need to consider complementary and alternative (CAM) therapies.  One reason might be that the more “traditional” medication therapies are not effective, despite dose optimization, or a given patient has issues with drug allergies, interactions, and/or adverse effects.  Or sometimes, patients and caregivers may desire complementary therapies.  In a study that took place in a palliative IPU, 82% of the patients surveyed were interested in trying CAM therapies, with the greatest interest expressed in music therapy (61% of patients) and massage therapy (58% of patients).  In this same study, 100% of “substitute decision makers” expressed an interest in having CAM therapies available for their loved ones to try.1  Furthermore, aromatherapy and music therapy typically have a favorable benefit-to-risk ratio, although every patient is unique and should be evaluated individually.

 

 

Exceptional pain and symptom management is an essential component of hospice care. Hospice clinicians must consider cost-management in addition to therapeutic appropriateness when choosing medications for their patients at the end-of-life. This article will focus on common end-of-life symptoms seen in the hospice setting, including pain, anxiety and agitation, nausea and vomiting, constipation, dyspnea, and terminal secretions and how to cost-effectively manage these symptoms.

 

In the US, drug overdose is the leading cause of death for persons under age 50, and those  between ages 18-25 are the most likely to use addictive drugs. Nine out of 10 people with substance problems started using by age 18. Those aged 18-25 years with substance use disorder (SUD) report getting 37.5% of their opioids from a friend or relative for free, and 19.9% report getting them from a friend or relative that they pay. 

 

The Lown Institute has identified medication overload, or polypharmacy, as a threat to the future of our healthcare system. Researchers found that almost 20% of older adults take 10 or more medications per day. The more medications a patient takes, the greater the risk of complications.  The US is on track to spend $62 billion on hospitalizations due to adverse drug events over the next 10 years. The good news is that hospice and palliative care clinicians are uniquely positioned to be part of the solution. Nurses and physicians can emphasize the importance of medication reviews and deprescribing to patients and families to stop these projections from becoming statistics.

 

1.  Inhalers with valved holding chambers (VHCs): use over nebulizers if clinically appropriate for your hospice patients with confirmed or suspected COVID-19.

A number of hospice COVID19 cases will still be more appropriate for nebs (e.g. if patient has severe, life-threatening respiratory symptoms, or is unable to use a chamber). The recommendations to prefer inhalers with VHCs over nebulizers is to reduce the amount of potentially infectious aerosol dispelled into the air during nebulization.1

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ProCare HospiceCare is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

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