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BMJ Support Palliat Care. 2017 Dec;7(4):450-457. doi: 10.1136/bmjspcare-2016-001229. Epub 2017 Sep 13.

Continuation of non-essential medications in actively dying hospitalised patients.

Author information

1
Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham VA Medical Center, Birmingham, Alabama, USA.
2
Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
3
Department of Medicine, Denver Health Medical Center, University of Colorado, Denver, Colorado, USA.
4
Palliative Care Section, Birmingham VA Medical Center, Birmingham, Alabama, USA.

Abstract

OBJECTIVE:

The objective of this analysis was to examine the use of 11 non-essential medications in actively dying patients.

METHODS:

This was a planned secondary analysis of data from the Best Practices for End-of-Life Care for Our Nation's Veterans trial, a multicentre implementation trial of an intervention to improve processes of end-of-life care in inpatient settings. Supported with an electronic comfort care decision support tool, intervention included training hospital staff to identify actively dying patients, communicate the prognosis to patients/families and implement best practices of traditionally home-based hospice care. Data on medication use before and after intervention were derived from electronic medical records of 5476 deceased veterans.

RESULTS:

Five non-essential medications, clopidogrel, donepezil, glyburide, metformin and propoxyphene, were ordered in less than 5% of cases. More common were orders for simvastatin (15.8%/15.1%), calcium tablets (8.4%/7.9%), multivitamins (11.6%/10.8%), ferrous sulfate (9.1%/7.6%), diphenhydramine (7.2%/5.1%) and subcutaneous heparin (29.9%/27.5%). Significant decreases were found for donepezil (2.5%/1.3%; p=0.001), propoxyphene (0.8%/0.1%; p=0.001), metformin (0.8%/0.3%; p=0.007) and multivitamins (11.6%/10.8%; p=0.01). Orders for one or more non-essential medications were less likely to occur in association with palliative care consultation (adjusted OR (AOR)=0.64, p<0.001), do-not-resuscitate orders (AOR=0.66, p=0.001) and orders for death rattle medication (AOR=0.35, p<0.001). Patients who died in an intensive care unit were more likely to receive a non-essential medication (AOR=1.60, p=0.009), as were older patients (AOR=1.12 per 10 years, p=0.002).

CONCLUSIONS:

Non-essential medications continue to be administered to actively dying patients. Discontinuation of these medications may be facilitated by interventions that enhance recognition and consideration of patients' actively dying status.

KEYWORDS:

end-of-life care; hospice care; hospital care; medications; palliative medicine

PMID:
28904011
DOI:
10.1136/bmjspcare-2016-001229
[Indexed for MEDLINE]

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