Are Opioid Infusions Used Inappropriately at End of Life? Results From a Quality/Safety Project

Yeh, Jonathan C.; Chae, Sul Gi; Lien, C.; Malecha, Patrick W.; Han, Harry J.; Buss, Mary K.; Lee, Kathleen A.

doi:10.1016/j.jpainsymman.2022.05.015

Cited by 2 publications

(1 citation statement)

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“…13,14 Inappropriate opioid infusion use at the end of life has been recently defined by an interdisciplinary group as (1) infusions initiated in opioid-naïve individuals (defined as having received less than 30 oral morphine equivalents in the prior 24-h), (2) infusions whose rate is escalated more than three times in a 24-h period, or (3) infusions started following the use of less than three as-needed opioid intravenous boluses over a 2-h period. 15…”

Section: Why Opioid Infusions Are Not Useful For Initial Symptom Mana...mentioning

confidence: 99%

Things We Do for No Reason™: Opioid infusions as initial therapy for symptoms at the end of life

Gelfand,

Drutchas,

Rosenberg

2023

Journal of Hospital Medicine

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A hospitalist admits a 75-year-old grandfather and retired factory worker with NYHA class IV congestive heart failure from ischemic cardiomyopathy and chronic obstructive pulmonary disease for the fifth time in the last 6 months for dyspnea. He has had progressive debility over the last year and is now bedbound. In the early morning hours before his admission, he experienced a witnessed aspiration event and presented to the emergency department with agonal respirations. He is lethargic and unable to verbally communicate or follow commands. His brother, the designated healthcare proxy, meets with the hospitalist, and they decide that the patient would wish to focus his care on the promotion of comfort at this point. The hospitalist removes medications and tests that are not focused on comfort, changes the vital signs to temperature and respiratory rate only every shift, and begins to consider adding orders to address symptom management in the last hours of life. To treat the patient's tachypnea (respirations approximately 22-24/min) with accessory muscle use, the hospitalist considers her pharmacologic options.

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Section: Why Opioid Infusions Are Not Useful For Initial Symptom Mana...mentioning

confidence: 99%