Comfort Pack reduces anxiety, improves care
Emergency meds decrease visits to the ED
An overnight delivery of pain medication that took four days and a charge of $125 for eight pills from a hospital pharmacy are two of the reasons that the staff at Hospice of the Hills in Rapid City, SD, started looking for a new way to help patients with emergency needs.
Responding to a hospice patient's need for additional medication to handle worsening pain or other symptoms is not easy, but when your hospice has patients who are 60 miles from the nearest pharmacy or from a hospice nurse, it is almost impossible to meet the patient's immediate needs, points out Dodie Brown, RN, director of the hospice. "Luckily, we are hospital-based and were able to work closely with our pharmacy to develop a solution," she says.
Working with the hospital pharmacist, Brown was able to identify medications that would treat the most common emergency symptoms. "The most common symptoms for emergency care are nausea and vomiting, anxiety, agitation, fever, excess secretions, pain, and bowel problems," says Brown. A standing order for a "comfort pack" of emergency medications was developed, and the physicians who refer patients to the hospice were surveyed about the prescription protocol developed for the medications, she explains. "We explained the need for patients to have an emergency pack of medications to get them through a 48-hour period until we could contact the physician, get an order for medication, and give the patient's family time to get to a pharmacy," she says. All of the physicians agreed to the protocol and agreed to the standing order.
Nurses educate family members upon admission to hospice and after they deliver the Comfort Pack, says Brown. The pack is kept in the refrigerator since it does contain suppositories, she adds.
The hospital pharmacy prepares the pack, placing the suppositories, tablets, and liquid medications into a box that is sealed with a tamper-evident seal, says Brandi Tackett, RPh, PharmD, hospital pharmacist. Patients are instructed to call the hospice nurse prior to opening the box, and a label on the box reminds them to call as well, she says.
Medications included in the Comfort Pack are four oncology suppositories for nausea and vomiting, six acetaminophen suppositories for fever with pain, four tablets of lorazepam for anxiety, 16 ml haliperodol for agitation, 16 ml atropine 1% ophthalmic solution for excess secretions, 10 ml morphine for pain, and two bisacodyl suppositories for bowel problems, says Tackett.
"The nurse will talk with the caregiver to determine which medications are needed and to go over the medication instructions before telling the caregiver to open the box," she says. "The nurse also notifies the physician if the Comfort Pack is accessed."
Because the patient already has the medication, there is no need to wake a physician at 3 a.m. for a prescription, she points out. "If the call from the patient is in the middle of the night, the nurse can have them start the medication, then send a fax to the physician's office for follow-up in the morning," she explains.
The Comfort Pack has not only improved the hospice's ability to respond to the needs of a rapidly declining patient in a rural area, but it has also reduced emergency department visits, says Brown. "Our physicians are also happy not to get middle of the night calls, and our nurses like to be able to immediately help the family," she adds.
The Comfort Pack is a good example of how you can plan ahead to meet needs, Brown says. "It saves time for nurses and physicians and reduces anxiety for our patients and family caregivers," she says.
An overnight delivery of pain medication that took four days and a charge of $125 for eight pills from a hospital pharmacy are two of the reasons that the staff at Hospice of the Hills in Rapid City, SD, started looking for a new way to help patients with emergency needs.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content