Medication Use in the Last Days of Life in Hospital, Hospice, and Home Settings in the Netherlands

Arevalo, Jimmy J.; Geijteman, Eric C T; Huisman, Bregje A. A.; Dees, Marianne; Zuurmond, W. W. A.; Zuylen, Lia van; Heide, Agnes van der; Pérez, Roberto

doi:10.1089/jpm.2017.0179

Cited by 30 publications

(37 citation statements)

References 23 publications

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“…30,31 Therefore, patients and informal carers are often charged with managing a great number of medications, with different routes of administration, prescribed for a variety of reasons, and often involving powerful drugs with a high risk of adverse side effects. 29,32 Arevalo et al 33 identified that seven days before death the mean number of medications being taken by patients was nine. Importantly on the day of death, 27% of patients used a preventative medication.…”

Section: Introductionmentioning

confidence: 99%

“…It is becoming clear within the literature that much greater understanding of polypharmacy is needed to understand why prescribing focus may not shift from the active management of comorbidities and chronic disease with such preventative medications to the provision of comfort care and effective control of symptoms at the end of life. 29,33,34 Professional respondents in the study by Dees et al 29 highlighted issues such as not wanting to diminish patients' hope, being unwilling to have difficult end-of-life conversations, and an emphasis on prescribing being the role and responsibility of a lead physician, as reasons for not undertaking the rationalization of unnecessary medications.…”

Section: Introductionmentioning

confidence: 99%

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Managing Medicines for Patients Dying at Home: A Review of Family Caregivers' Experiences

Wilson

Caswell

Turner

et al. 2018

Journal of Pain and Symptom Management

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As increasing demands are placed on FCGs, there remains limited acknowledgment or understanding of the challenges they face, how they cope, or could be best supported. Alongside training, FCGs need access to 24 hours of support and medication reviews to rationalize unnecessary medications. Furthermore, the ethical challenges arising from administering medicines at the end of life also need to be acknowledged and discussed.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Managing Medicines for Patients Dying at Home: A Review of Family Caregivers' Experiences

Wilson

Caswell

Turner

et al. 2018

Journal of Pain and Symptom Management

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“…In terms of EOL medications, our study showed in the last 3 days of life, charting of opioids was 87%, benzodiazepines 73% and antipsychotics 43%, which compares favourably with a retrospective cohort study of three RACFs in Norway, that showed on the last day of life, Morphine was charted in 71.4%, Midazolam 55% and Haloperidol 46.9% [ 50 ]. In terms of administration of EOL medications, there have been two recent retrospective cohort studies from the Netherlands, one conducted in a PCU [ 51 ] and another conducted in hospital, hospice and home settings [ 52 ]. These studies of the last days of life, have measured the proportion of use of specific medications, types of medications (palliative vs preventative) and medication classes, the total amount given in milligrams each day and route of administration.…”

Section: Discussionmentioning

confidence: 99%

Residential aged care residents and components of end of life care in an Australian hospital

Leong¹,

Crawford

2018

BMC Palliat Care

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BackgroundWith ageing of Australians, the numbers of residential aged care (RAC) residents is rising. This places a spotlight on decisions about appropriate care for this population, including hospitalisation and end-of-life (EOL) care. The aim was to study a sample of RAC residents who attended and died in hospital, to quantify measurable components of EOL care so as to describe the extent of palliative care required.MethodsA retrospective case-note review of hospital records was conducted in Adelaide, Australia. Participants were 109 RAC residents who attended from July 2013 to June 2014 and died in hospital.Measurements were advance care planning, health care input from the RAC facilities to hospital and components of EOL care. Residents with and without advanced dementia were compared.ResultsAdvance care directives (ACDs) were present from 11 to 50%, and advance care plans (ACPs) at 60%. There were more ACPs, resuscitation orders (for/against) and do-not-hospitalise orders in residents with advanced dementia than those without. General practitioner (GP) and extended care paramedic (ECP) input on decisions for hospital transfer were 30% and 1 %. Mean hospital stay to death was 5.2 days. For residents admitted under non-palliative care teams, specialist palliative care (SPC) was needed for phone advice in 5%, consultation in 45%, transfer to palliative care unit in 37%, and takeover by SPC team in 19%. Mean number of documented goals-of-care discussions with family/caregiver was 1.7. In the last 3 days of life, the mean daily number of doses of EOL medications was 4.2. Continuous subcutaneous infusion was commenced in 35%.ConclusionStaff in RAC need to be adequately resourced to make complex decisions about whether to transfer to hospital. RAC nurses are mainly making these decisions as GP and ECP input were suboptimal. Ways to support nurses and optimise decision-making are needed. Advance care planning can be improved, especially documentation of EOL wishes and hospitalisation orders.By describing the components of EOL care, it is hoped providers and policy makers have more information to assist with making decisions about what is the most appropriate care for this population.

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“…Experts in our study gave specific suggestions for research and development. Whereas a substantial part of medications in end-of-life care are prescribed for comorbid diseases, 16 there is an urge for reflection on how to manage those medications at the end of life and to address this issue in treatment guidelines. Pharmacological guidelines rarely give any recommendations for discontinuation.…”

Section: What This Study Addsmentioning

confidence: 99%

Better drug use in advanced disease: an international Delphi study

Huisman

Geijteman²,

Dees³

et al. 2018

BMJ Support Palliat Care

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Patients with a limited life expectancy use many medications, some of which may be questionable.Objectives To identify possible solutions for difficulties concerning medication management and formulate recommendations to improve medication management at the end of life.Methods A two-round Delphi study with experts in the field of medication management and end-of-life care (based on ranking in the citation index in Web of Science and relevant publications). We developed a questionnaire with 58 possible solutions for problems regarding medication management at the end of life that were identified in previously performed studies.Results A total of 42 experts from 13 countries participated. Response rate in the first round was 93%, mean agreement between experts for all solutions was 87 % (range 62%–100%); additional suggestions were given by 51%. The response rate in the second round was 74%. Awareness, education and timely communication about medication management came forward as top priorities for guidelines. In addition, solutions considered crucial by many of the experts were development of a list of inappropriate medications at the end of life and incorporation of recommendations for end-of-life medication management in disease-specific guidelines.Conclusions In this international Delphi study, experts reached a high level of consensus on recommendations to improve medication management in end-of-life care. These findings may contribute to the development of clinical practice guidelines for medication management in end-of-life care.

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Medication Use in the Last Days of Life in Hospital, Hospice, and Home Settings in the Netherlands

Abstract: Patients who die an expected death receive many medications in the last week of life, part of which are preventive medications. Medication management in patients' final days of life can be improved, especially in the hospital and home setting.

Cited by 30 publications

References 23 publications

Managing Medicines for Patients Dying at Home: A Review of Family Caregivers' Experiences

Managing Medicines for Patients Dying at Home: A Review of Family Caregivers' Experiences

Residential aged care residents and components of end of life care in an Australian hospital

Better drug use in advanced disease: an international Delphi study

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