Hospice care plays an important role in improving patient satisfaction and providing a better end-of-life experience. Often confused with palliative care, which begins at diagnosis and occurs in conjunction with treatment, hospice care begins after treatment has stopped when the physician no longer expects the patient to survive the illness. At this point, the hospice team works closely with the patient’s family/caregivers to ensure that the patient spends his or her remaining days with dignity and in comfort.
Across all healthcare mediums, but especially in hospice, optimizing the patient experience takes a team-oriented approach to medical care, pain management, emotional and spiritual support that is tailored to the patient’s needs and wishes.
An important member of this team includes the pharmacist whose expertise supports the medical team in solving issues related to the patient’s pain and discomfort. Through collaboration and open communication, the pharmacist plays an essential part in helping to prevent unwanted drug interactions and side effects while optimizing the patient experience and family/caretaker satisfaction.
Avoiding Polypharmacy Among Hospice Patients
Polypharmacy, the use of multiple drugs concomitantly and/or the administration of more medications than clinically indicated, is one area that illustrates the impact of a great working relationship between the pharmacist and nurse/prescribing doctor. Polypharmacy is a common problem in hospice, and it is associated with a host of serious problems, including falls, decreased cognition, increased risk of ADRs and diminished quality of life.
To reduce polypharmacy and achieve a more comfortable hospice patient experience requires the collaborative efforts of medical professionals and the pharmacist to re-evaluate regimens regularly, especially when goals of care change.
Consider the case of an elderly woman with a terminal diagnosis of dementia living at home who was taking upwards of 20 medications to address depression, hypertension, and hyperlipidemia. Hospitalized for pneumonia, her condition declined, and she was confined to a bed – with difficulty swallowing, no longer communicating, sleeping during the day and restless at night.
Once she was released from the hospital, her hospice nurse grew concerned that her husband, who was anxious and exhausted, might be unable to administer her medications because of the patient’s swallowing difficulties.
The nurse contacted a pharmacist that specialized in hospice care to discuss options for deprescribing. The pharmacist recognized that, given the patient’s complex comorbid conditions and older age, the risk of drug-drug interactions, drug-disease interactions and adverse effects (ADRs) was high for this patient, and probably contributing to her discomfort and debility.
As a first step, the pharmacist re-evaluated the patient’s medication regimens and then discussed and coordinated proposed changes with the medical team and the woman’s husband to develop a care plan. At first, the husband was reluctant to remove medications, but both the hospice nurse and pharmacist were able to gain his trust and assured him of the benefits of the proposed changes.
A Great Working Relationship
After eliminating the medications that were causing distress and providing no benefit to the patient, the hospice nurse found that the patient was calmer and able to sleep through the night. Her husband was also able to relax and focus more on spending time with his wife rather than feeling stressed about managing so many medications.
This case study exemplifies how hospice nurses, medical providers and hospice pharmacists work together to ensure the utmost comfort for patients during end-of-life care. During Patient Experience Week, let’s all show our support and appreciation for the men and women who provide hospice care — and peace of mind for families and caretakers.