To examine comfort medication (CM) and noncomfort (NC) medication use in inpatients comanaged by palliative care (PC) near the end of life.
Methods:
Chart review of inpatients comanaged by the PC service at 2 academic hospitals. Medications were categorized as CM and NC medication according to the published guidelines.
Results:
Seventy patients met inclusion criteria. In the final week of life, inpatients were receiving a mean of 6 CM (40 doses) and 7 NC medications (41 doses). Four new NC medications were started per patient, but only 3 were discontinued. The NC medications were most frequently discontinued on the day of PC consult, but 14% were stopped on the day of death/PC unit transfer.
Conclusion:
Inpatients comanaged by PC continue to receive NC medications as they near the end of life.
EggerSSBachmannAHubmannNSchliengerRGKrahenbuhlS. Prevalence of potentially inappropriate medication use in elderly patients: comparison between general medical and geriatric wards. Drugs Aging. 2006;23(10):823–837.
3.
CorsonelloAPedoneCCoricaFIncalziRA. Polypharmacy in elderly patients at discharge from the acute care hospital. Ther Clin Risk Manag. 2007;3(1):197–203.
4.
LauHSFloraxCPorsiusAJDe BoerA. The completeness of medication histories in hospital medical records of patients admitted to general internal medicine wards. Br J Clin Pharmacol. 2000;49(6):597–603.
5.
WongJDBajcarJMWongGG. Medication reconciliation at hospital discharge: evaluating discrepancies. Ann Pharmacother. 2008;42(10):1373–1379.
6.
CurrowDCStevensonJPAbernethyAPPlummerJShelby-JamesTM. Prescribing in palliative care as death approaches. J Am Geriatr Soc. 2007;55(4):590–595.
7.
FedeAMirandaMAntonangeloD. Use of unnecessary medications by patients with advanced cancer: cross-sectional survey. Support Care Cancer. 2011;19(9):1313–1318.
8.
RiechelmannRPKrzyzanowskaMKZimmermannC. Futile medication use in terminally ill cancer patients. Support Care Cancer. 2009;17(6):745–748.
9.
De LimaLDDoyleDMacDonaldNKrakauerELLorenzKPraillDFoleyK. Ensuring palliative medicine availability: the development of the IAHPC list of essential medicines for palliative care. In: HanksGCNathanIChristakisNAFallonMKaasaSPortenoyRK, eds. Oxford Textbook of Palliative Medicine. 4th ed.New York, NY: Oxford University Press; 2009:32–40.
10.
NéronA. Table 31.1—classification of drugs according to medical necessity at end of life. In: Hospital Pharmacists' Special Interest Group in Palliative Care, ed. Care Beyond Cure: Management of Pain and Other Symptoms. 4th ed.Canada: Association des pharmaciens des etablissements de sante du Quebec, Sandoz; 2009.
11.
HowardLSHughesRJ. NICE guideline: management of venous thromboembolic diseases and role of thrombophilia testing. Thorax. 2013;68(4):391–393.
12.
O'BrienCP. Withdrawing medication: managing medical comorbidities near the end of life. Can Fam Physician. 2011;57(3):304–307, e389–392.
13.
ParsonsCHughesCMPassmoreAPLapaneKL. Withholding, discontinuing and withdrawing medications in dementia patients at the end of life: a neglected problem in the disadvantaged dying?Drugs Aging. 2010;27(6):435–449.
14.
TownsKDoughertyEKevorkN. Availability of services in Ontario hospices and hospitals providing inpatient palliative care. J Palliat Med. 2012;15(5):527–534.
15.
DownarJChouYCOuelletD. Survival duration among patients with a noncancer diagnosis admitted to a palliative care unit: a retrospective study. J Palliat Med. 2012;15(6):661–666.
16.
DownarJBaruaRRodinD. Changes in end of life care 5 years after the introduction of a rapid response team: a multicentre retrospective study [published online March 15, 2013]. Resuscitation. 2013.
17.
DownarJRodinDBaruaR. Rapid response teams, do not resuscitate orders, and potential opportunities to improve end-of-life care: a multicentre retrospective study. J Crit Care. 2013;28(4):498–503.
18.
EllershawJWardC. Care of the dying patient: the last hours or days of life. BMJ. 2003;326(7379):30–34.
19.
EllershawJWS. Care of the Dying: A Pathway to Excellence. 2nd ed.Oxford: Oxford University Press; 2011.
20.
EllershawJE FAMurphyDSheaTOverillS. Developing an integrated care pathway for the dying patient. Eur J Palliat Care. 1997;4(6):203–207.
