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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

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



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


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.


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).


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.


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

[Indexed for MEDLINE]

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