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The One Item All Hospices Should
by Dr. Ike’s Pharmacare’s Pharmacist-in-Charge
Dr. Harout Keuroghlian, PharmD
The single most important medication order any hospice should obtain before all else is the Emergency Kit. So what is an E-kit? At Dr. Ike’s PharmaCare we build our E-kits to help patients with any one of the following conditions: pain, shortness of breath, difficulty swallowing, agitation, anxiety, excessive secretions, constipation, and nausea/vomiting. On many instances, I have seen hospices order E-kits too late after a patient has been admitted. This usually leads to unnecessary pain and suffering for patients as well as family members who must witness it. Through the difficult time the family must endure, the last issue anyone wants to worry about is whether the medication is there or not. To avoid this problem, having an E-kit beforehand provides three benefits:
Decrease the need for hospices to place STAT orders where delivering the medication in a timely manner may be an issue, along with potentially higher costs/order.
Decrease the anxiety/stress for hospice staff and patients that comes from not having the medication on hand when needed.
Increase family/patient satisfaction because the hospice insures patient comfort before possibly passing on.
The primary items in Dr. Ike’s E-Kits is the necessary Morphine (Roxanol) for pain/shortness of breath. Patients who have difficulty swallowing can also use Roxanol sublingually which will still provide adequate drug absorption into the bloodstream through the buccal route. In the case the patient is allergic to morphine or codeine, the hospice can contact the pharmacist for alternatives that will decrease the risk of any hypersensitivity reaction from occurring. To treat agitation, anxiety, and restlessness, the Dr. Ike’s E-kit also contains Haloperidol (Haldol) or Ativan (Lorazepam) liquid which may also be used sublingually if patients have difficulty swallowing. For excessive secretions, we have anticholinergic agents such as compounded Atropine 1.5% or Hyoscamine tablets/drops. For constipation, Bisacodyl (Dulcolax) suppository can be used for patients who are on higher opioid doses or have low motility. For mild pain/fever the E-kit also contains Acetaminophen (Tylenol) suppositories, an excellent choice for geriatric patients to avoid liver toxicity via rectal route. Finally, for patients experiencing nausea/vomiting, we have compounded Prochlorperazine (Compazine) in mixture with either Metoclopramide (Reglan) or Haloperidol.
The Dr. Ike’s E-kit medications listed above may be ordered as individual orders or at one time as a complete E-kit. I hope this article is a good resource for hospices looking to maximize their level of service. Contact Dr. Ike’s Pharmacare for more detail on pricing and order an E-Kit Today! www.PharmaCareLTC.com