Hospice Emergency Kit for Veterans: A Pilot Study

Abstract

HEKs have value as a means to alleviate many symptoms that emerge predictably in home hospice patients and may avoid unwanted hospitalizations and ED visits.

Impact of a Hospice Emergency Kit for Veterans and Their Caregivers: A Prospective Cohort Study

“…However, our results are concordant with prior studies examining the perspectives of hospice nurses. These studies demonstrate that nurses believed HEKs were helpful most of the time, 9 helped avoid ED visits and/or hospitalization, [9][10][11] and increased patient and family satisfaction. 11 The most commonly used medications were morphine concentrate, lorazepam, levofloxacin, and promethazine for nausea and vomiting.…”

“…It is standard of care that all Birmingham VAMC veterans entering home hospice are offered a HEK. 9 VA palliative care physicians, including one of the authors (AB), maintained oversight as the attending physicians of record and were on 24-hour call to assist with symptoms not controlled with the HEK, as well as problems outside the scope of the HEK. Hospice agencies delivered interdisciplinary care and provided medications related to the hospice diagnosis, with the exception of the VA HEK.…”

“…3,4 However, the literature related to the utilization and impact of HEKs is currently sparse. [5][6][7][8][9][10][11][12][13] One study has demonstrated that HEKs alone reduced the odds of ED visits by 67%, and the odds were reduced by 75% when there was a caregiver in the home. 7 Surveys of hospice nurses and nurse managers indicate that medication kits are well received, 8,9 help to avoid ED visits, 10,11 save costs, 11 and increase patient/family satisfaction.…”

“…[5][6][7][8][9][10][11][12][13] One study has demonstrated that HEKs alone reduced the odds of ED visits by 67%, and the odds were reduced by 75% when there was a caregiver in the home. 7 Surveys of hospice nurses and nurse managers indicate that medication kits are well received, 8,9 help to avoid ED visits, 10,11 save costs, 11 and increase patient/family satisfaction. 11 However, to our knowledge, no studies have examined patient-or caregiverreported perspectives, including how and when the kits are utilized, and whether such use effects symptom relief, produces negative effects, or impacts patients/caregivers in a positive or negative way.…”

Supporting patient access to medicines in community palliative care: on-line survey of health professionals’ practice, perceived effectiveness and influencing factors

“…A small number of studies in the US [9][10][11] point to the effectiveness of anticipatory prescribing kits in home hospice care as a way of increasing timely patient access to medicines in the home, but internationally, there is a lack of research into how health professionals and different systems of care delivery shape patients' experience of access to medicines.…”