Medication Changes Initiated after Palliative Care Consult in Hospitalized Patients: A Focus on Changes in Analgesic and Chronic Disease Medication Regimens

This is the authors' abstract. We don't add key points for this paper.

Literature guiding clinicians on appropriate prescribing as death nears is scarce. The aim of this study was to retrospectively evaluate medication changes implemented after palliative care consultations at two VA (veterans affairs) end-of-life care units. Analysis focused on the change in analgesic and chronic disease medication regimens, including administration route. Sixty patients who received an inpatient palliative care consult and subsequently passed away on the either VA end-of-life care unit between June 30, 2010 and June 30, 2011 were included for analysis. Opioid and non-opioid analgesic medications were distinguished in this study. Medication name and route of administration were documented from inpatient electronic medication profiles up to one week prior to the inpatient palliative care consult (T prior ), the day after consult (T +1 ), and the day of death (T death ). Opioid analgesic medications prescribed increased from 0.95 per patient prior to consult to 1.87 at death. Investigators observed a shift away from oral opioid analgesic formulations to intravenous and subcutaneous push as the preferred routes of administration at time of death. Chronic medications decreased from 5.15 per patient prior to consult to 1.23 at death. The overall increase in analgesic medications at time of death reflects a focus on symptom management and comfort care in this special population. Trimming of non-essential medications is a patient-specific art and continued efforts should be made to reduce pill burden by removing medications that are not directly related to comfort-care in the palliative patient as death approaches.