How to Manage Hospice Meds Efficiently and Compassionately
The point at which a patient's care has reached the hospice or palliative-only stage — when the remaining phase of their life cycle is best measured in weeks, days or even hours — is an immensely difficult threshold to cross. Emotions will be at their most intense among any family or other loved ones still in the patient's orbit (and, not infrequently, caregivers who have spent a particularly long time working with the individual in question).
Also, any circumstances adversely affecting the medication supply chain for the hospice patient's long-term care facility and pharmacy, or problems with the latter's LTC pharmacy software, will have a much more negative impact on end-of-life care than would be the case with healthier patients. Above all, you have a human being in terrible pain, unaware of their environment, in deep fear of death or some combination thereof who must be treated appropriately and with respect.
Taking all of this into account, it's critical to closely review the procedures by which LTC pharmacies and facilities address the final needs of their hospice patients. The best practices for improving the process should include everything ranging from streamlining the roles of nurses to upgrading the LTC pharmacy solution to better match modern hospice pharmacy expectations.
Looking at the bigger picture of hospice
In the Clinical Excellence and Safety section of its Standards of Practice, the National Hospice and Palliative Care Organization establishes a key principle that should be considered in all initiatives to improve hospice care:
"The desired outcomes of hospice interventions are for patients to feel safe and comfortable throughout the dying process; and for patients and families to feel supported and have adequate information appropriate to their needs … Hospice outcomes are individualized through a collaborative and reiterative process." NHPCO cites the most important elements of that process as "continuous assessment and identification of the goals, needs, strengths and wishes of the patient and family/caregiver."
LTC pharmacies and their technicians, consulting pharmacists, and leading administrators would do well to observe those principles. They should consider themselves just as important to the hospice process as any of the other key figures connected to it. Pharmacy staff don't interact with hospice patients the way nurses and facility personnel do, but that doesn't make their role any less important. Viewing themselves as key stakeholders with a primary connection to the caregiving arena will help drive better and more efficient delivery of palliative medications.
The role of family in home-care situations
Not infrequently, patients at the hospice care stage of their illnesses choose to live the final days of their lives in the comfort of their own home. LTC facilities — and pharmacies — are often involved in these arrangements: They have much less complete oversight, but they still have a noteworthy role to play.
The key to success in this context is to be cognizant of every party's role in this ecosystem — and make the most of it. As noted in a study published by the Journal of Pain and Symptom Management, family caregivers can become quite capable in the area of medication management and adherence throughout the hospice process. But, quite understandably, they often aren't capable of going it alone in such a trying and emotionally fraught setting. They need to have ready access to support from skilled nurses and physicians — as well as LTC pharmacies that have been equipped with the most advanced, streamlined pharmacy solutions.
Improving liaisons with nurses
Offering palliative care is nothing short of a tightrope walk even before a patient's illness reaches the stage where hospice care is necessary. After that point, the proverbial "rope" becomes almost razor-thin. However, a 2020 study in the BMC Palliative Care journal found that it's not uncommon for physicians to review medication regimens less thoroughly than they should. This practice can lead to the prescribing of potentially inappropriate medications (PIMs). Many of the drugs utilized as hospice medication are opioids and other very powerful narcotics that carry certain risks no matter what, but there's no reason whatsoever to invite completely unnecessary hazards through PIM prescriptions.
The BMC study recommended that nurses can circumvent issues like this by taking more of a leadership position in medication management. They interact more directly and more often with hospice patients than anyone else. Facility and hospice pharmacy staff would do well to communicate with palliative-care nurses as often as possible.
Maximizing performance for hospice med distribution systems
Last but not least, it's critical to stress that time is of the essence when distributing meds for hospice patients. Time is, unfortunately, no longer their ally, and key prescriptions need to be ready within an hour or less. Using standard retail pharmacy or community pharmacy software simply doesn't provide the expediency or efficiency that's necessary for this situation.
With FrameworkLTC, pharmacists and technicians handling hospice med orders never have to worry about prescriptions slipping through the cracks at this critical time or falling behind their filling schedules. Through tried-and-true interfaces with trusted systems like PointClickCare and compatibility with dozens of central fill packaging, courier and eMAR/EHR tools, you can rest assured that FrameworkLTC can help you provide hospice patients as much comfort as possible and to do so with speed, efficiency, and kindness.