Pet Peeves in Hospice Care

Working in assisted livings and long term care facilities for a large chunk of my career, its safe to say I’ve reviewed a few patients medications who are on hospice. I have three major pet peeves in hospice care that I feel like I encounter on a regular basis.

Duplicate Therapy

The first of those pet peeves in hospice care is duplicate therapy. In particular, antipsychotics drive me a little crazy. I’m not opposed to patients having antipsychotics for distressing delusions, aggression, or end-of-life agitation. Where I get a little more frustrated is when the patient has multiple antipsychotics on board. The most commonly used antipsychotics that I see used in hospice are quetiapine and haloperidol. If two antipsychotics (typically PRN) are necessary, there better be a good rationale. One rationale is where I have seen haloperidol used for nausea and quetiapine used for hallucinations or delusions. Ideally, we do not want two antipsychotics (or other medications for that matter) to be used for “anxiety” or “agitation”. This puts caregivers in a little more difficult spot as they may not have received guidance as to which medication should be used.

Vitamins and Supplements

I still see patients on hospice taking vitamin E, vitamin C, and other supplements. In my opinion, there really isn’t a great rationale to increase the pill burden on these patients in whom we should try to maximize their quality of life. Be sure to go through the medication list and address every supplement and vitamin that the patient is taking. We can likely discontinue most of them.

Other Medications to Discontinue

A risk versus benefit analysis should be done with all of these medications, but in many situations, we can discontinue aspirin, statins, and bisphosphonates in hospice patients. These are great targets to potentially reduce pill burden while also recognizing the risks of not taking these medications. While we generally know which medications are not going to benefit a patient near the end of their life, please keep in mind that discussions need to occur with family members and loved ones when deciding which medications to discontinue. They may have strong beliefs about a particular medication or supplement based on the patient’s past healthcare experiences.

What hospice pet peeves do you have?

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Written By Eric Christianson

September 28, 2022

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