Soliciting an Herbal Medicine and Supplement Use History at Hospice Admission

Abstract

Background: Reconciling medication use and performing drug utilization review on admission of a patient into hospice care are essential in order to safely prescribe medications and to prevent possible adverse drug events and drug-drug interactions. As part of this process, fully assessing herbal medicine and supplement use in hospice patients is crucial, as patients in hospice may be likely to use these medications and may be more vulnerable to their potential adverse effects. Objective: Our purpose was to identify herbals, vitamins, and supplements that should be routinely assessed on every hospice admission because of their higher likelihood of use or higher risk of adverse effects or drug interactions. Methods: Experts in the fields of palliative medicine, pharmacy, and alternative medicine were asked to complete a Web-based survey on 37 herbals, vitamins, supplements, and natural products, rating likelihood of use, potential for harm, and recommendation to include it on the final list on a scale of 1 to 5 (least to most likely to agree). Results: Twenty experts participated in the survey. Using a cutoff of 3.75 for inclusion of a medication on the final list, 12 herbal medicines were identified that should be routinely and specifically assessed on hospice admission. Conclusions: Although assessing all herbal medicine use is ideal, thorough detection of herbals may be challenging. The list of herbals and supplements identified by this survey could be a useful tool for medication reconciliation in hospice and could aid in identifying potentially harmful medication use at the end of life.

Impact of pharmacy-led medication reconciliation on admission to internal medicine service: experience in two tertiary care teaching hospitals

“…When assessing potential severity, most of the unintended discrepancies (63%) were judged as clinically insignificant, where the error was less likely to cause harm, such as the omission of a dietary supplement or the omission of an antacid [40]. Around 36% of unintended discrepancies were judged as clinically significant, where the error had the potential to cause harm and may have required additional monitoring, such as omission/wrong dose of a beta-blocker.…”

Deprescribing in Hospice Patients: Discontinuing Aspirin, Multivitamins, and Statins

“…A summary of the literature supporting deprescribing of these medications, focusing on benefits and harm reduction, was also included in the resource tool. [13][14][15][16][17][18][19][20] Our team met with the entire hospice nursing team to provide basic education on the importance of deprescribing and how to use the resource guide.…”

“…10 In particular, medications prescribed for primary prevention are no longer indicated at the end of life. 10,[12][13][14][15][16][17][18][19][20][21] Studies suggest that aspirin, multivitamins, and statins are key targets for deprescribing in hospice patients to reduce adverse events and to improve quality of life. 10,[12][13][14][15][16][17][18][19][20][21][22][23] Unfortunately, time limitations, provider uncertainty about the ongoing benefits of medications, and reluctance of patients to change medications are significant barriers to deprescribing.…”

“…10,[12][13][14][15][16][17][18][19][20][21] Studies suggest that aspirin, multivitamins, and statins are key targets for deprescribing in hospice patients to reduce adverse events and to improve quality of life. 10,[12][13][14][15][16][17][18][19][20][21][22][23] Unfortunately, time limitations, provider uncertainty about the ongoing benefits of medications, and reluctance of patients to change medications are significant barriers to deprescribing. 4,6,24,25 This information suggests a substantial opportunity to streamline the deprescribing process for hospice patients and to improve provider confidence.…”