Kathryn Walker

Perceived Value and Cost of Providing Emergency Medication Kits to Home Hospice Patients in Maryland

Many hospices have adopted the use of ‘‘emergency medication kits’’ (EMK) to allow for management of emergent symptoms and to prevent unscheduled patient interventions. The purpose of this study was to compare perceptions of hospice managers and clinicians regarding the value of EMK and to assess outcomes. Clinical managers and clinicians reported that EMK were valuable in preventing emergency department visits, unscheduled nursing visits, pharmacy deliveries, and increased satisfaction. A hospice using EMK reported fewer calls requiring unscheduled interventions (18% vs 33%) and resulted in cost savings (US

Fifty Reasons to Love Your Palliative Care Pharmacist

23.04 per call vs US

Effectiveness of Integration of Palliative Medicine Specialist Services into the Intensive Care Unit of a Community Teaching Hospital

31.62 per call). Hospice managers and clinicians perceived EMK to be valuable in areas of quality, cost, and satisfaction. There appears to be an advantage to routinely providing EMK for home hospice patients.

Impact of Standardized Palliative Care Order Set on End-of-Life Care in a Community Teaching Hospital

Pharmacists have much to offer in caring for patients with an advanced illness. To celebrate the role of pharmacists in palliative care, we wanted to share 50 excellent reasons to love your pharmacist. This list was compiled by 3 pharmacists specializing in end-of-life care spanning from inpatient palliative care to home-based hospice. Our goal is to increase awareness among other hospice and palliative care practitioners by recognizing the skills pharmacists contribute in caring for patients at the end of life. We divided the list into categories: provision of pharmaceuticals, optimizing medication regimens, education and drug information, patient safety, and administration/formulary management.

Role of the pharmacist in palliative care

BACKGROUND Collaboration between palliative medicine and the intensive care unit (ICU) represents best practice and offers important benefits. However, achieving effective collaboration between these two specialties can be challenging. OBJECTIVE Assess effectiveness of integrating palliative medicine specialists in the ICU. DESIGN Retrospective chart review. RESULTS Of 201 patients who qualified for palliative consultation using a palliative screening tool, 92 were referred and 109 were not referred for palliative medicine consultation. The number of screening criteria met was similar between the two groups. Palliative medicine consult volume increased significantly compared with preintegration (7.7±3.4 versus 4.4±2.8 consults per month, p=0.04). No significant difference in hospital mortality was found between the referred and unreferred groups (32/92 [35%] versus 26/109 [24%], p=0.09). ICU length of stay was significantly shorter in the referred group (7 versus 11 days, p<0.001). Referred patients were more frequently enrolled in hospice compared with unreferred patients (32/92 [37%] versus 3/109 [3%], p<0.001). ICU physicians referred patients significantly more often for dementia and ventilator withdrawal (13/16, p=0.003; 24/29, p<0.001, respectively) and significantly less often for ICU stay longer than 10 days (21 versus 49, p=0.001). CONCLUSIONS Integrating palliative medicine specialists into intensive care was associated with a significant increase in use of palliative medicine services and a significant decrease in ICU length of stay for referred patients without a significant increase in mortality. The screening tool effectively identified patients at high risk of death. Given the high mortality rate of the unreferred patients, the criteria could be more widely adopted by ICU physicians to consider expanding palliative medicine referrals.

50 practical medication tips at end of life.

BACKGROUND We evaluated use of medications and interventions in patients receiving a new standardized palliative care order set (PCOS) compared with patients receiving no palliative care orders and those with an order for comfort measures only (CMO), the largely ineffective method used at our institution before implementation of the order set. METHODS AND RESULTS We conducted a retrospective chart review of all patients who died at our community teaching hospital between November 2006, 8 months after PCOS implementation, and May 2007. Of 106 patients in the study group, 31 (29%) were treated using the PCOS, 6 (6%) received the CMO order, and 69 (65%) did not receive either. Patients in the PCOS group had significantly more orders for every palliative medication (p ≤ 0.05). Opioids and anxiolytics were made available to every patient in the PCOS group. Most PCOS patients received orders for antiemetic, antipsychotic, antisecretion, and laxative medication during the end-of-life period. No CMO patients and few patients in the no palliative care orders group received orders for these medications. The PCOS and CMO group similarly limited nonpalliative interventions, whereas the nonpalliative group had relatively high use of these interventions until death. CONCLUSION The palliative care order set implemented at our community teaching hospital significantly improved adherence to accepted palliative care treatment principles for patients at the end of life.

A review of common methods to convert morphine to methadone

Abstract Pharmacists are uniquely positioned to provide expert medication advice and education, thus creating a specialised role within the team providing end-of-life care dedicated to rational medication use. The role of pharmacists varies among different palliative care practice settings; however, all pharmacists participate in providing pharmaceutical care. Countries vary greatly in the accepted definitions to describe pharmaceutical care and in the scope of pharmacy practice. Activities of pharmacists can include detecting and resolving drug-related problems, advising providers on appropriate medication use, medication reconciliation, creating medication guidelines, education and many more. Pharmacy organisations support pharmacists as key members of interdisciplinary care, and there is growing recognition of the value of their contribution. This review will explore the role of the pharmacist and available literature supporting outcomes associated with pharmacy involvement in palliative care. Pharmacists provide valuable patient care, contribute to a growing literature base of medication knowledge, and participate in the education of patients, families and fellow professionals.

Palliative Care Integration for Patients Receiving Left-Ventricular Assist Device (LVAD) as Destination Therapy (SR) (TH310D)

Patients with a life-limiting illness frequently experience pain and other symptoms. It is important to pay close attention when medication therapy is used to manage these symptoms. Occasionally, practitioners need to be creative in selecting, dosing, administering, and discontinuing medications at the end of life because of the patients changing health care needs. This article offers practical end-of-life medication tips including, but not limited to, medication administration; guidance on how to increase and decrease doses; medication selection for difficult-to-treat patients; alternative dosage formulations; routes of medication administration; debridement medication regimens; and appropriate drug therapy selection.

Passing the Last Torch: Pharmaceutical Transitions at the End of Life (FR403)

When dosed appropriately on carefully chosen patients, methadone can be a very safe and effective choice in managing chronic pain. Many authors have discussed important issues surrounding patient selection, drug interactions, screening for QTc prolongation and monitoring. This article will focus on the dosing dilemma that exists after the patient is deemed an appropriate candidate for methadone and a conversion is necessary from another opioid. Despite many publications dedicated to addressing this challenging topic, there is no consensus on the most appropriate method for converting an opioid regimen to methadone. Given the lack of concrete guidance, clinicians in a community setting are likely to be faced with an increased challenge if there are no available pain specialists to provide clinical support. Common methods for converting morphine to methadone will be reviewed and two clinical patient scenarios used to illustrate the outcomes of applying the methods.

Evaluating the Impact of a Protocol for Terminal Withdrawal of Mechanical Ventilation (S761)

5-point Likert scale was used. Responses