End of Life Care

[Pond Life]

Hi all,

I was just wondering how you guys in the States approach adjusting End of Life care drugs in the community.

Do your policies allow you to alter common E-of-L care drugs for breakthrough pain and other common issues such as hallucinations, nausea, secretions and the like by increasing anticipatory medicines such as Diamorphine, Levomepromazine/Metaclopramide, Hyoscine Hydrobromide, Midazolam and Haloperidol?

It's only just coming in here that we can do this so is fairly new for us I was interested in your experiences.

cheers

 

[WolfmanHarris]

https://myhealth.alberta.ca/palliative-care/health-care-professionals/ems-resources

Here's a program from out in Alberta that I had the opportunity to check out at a conference last year. Fantastic program I'm hoping we'll see in Ontario in the future.

 

[Pond Life]

Thank you for this, most interesting, I am trying to understand and learn from other systems on how we can improve our system.

I think I have read this right that when EMS arrive they contact palliative care doctor and s/he will give authority to alter/increase drugs - is that right?
I ask as I am unsure if loading patient palliative care drugs would come under 'emergency' drugs in this scenario.

Historically in the UK we couldn't amend the patient drugs and our palliative care nurses don't work 24/7 hence there is a shift toward EMS becoming involved in the care plans. There are now Just In Case Boxes (JICB) that have been put together by the palliative care team and patient doctor (reviewed often) and in it are a range of drugs and recommended doses that the drugs can be increased by. This is normally 1/6 of daily dose in the case of analgesia. This system has helped a lot in the early hours of the morning and reduces unnecessary ED transports.