Does your company recommend dc'ing all routine meds,including blood sugar control upon admission? What do you do if a family is pushing you to do this and the patient is still alert and sitting up,eating three meals a day? I feel that blood sugar control at this point is a comfort measure,this resident is not going anywhere fast but the family seems to want to hasten the process for their convenience.
Oct 16, '12
It depends on the patient's acuity level. For the patient you described, no we would not d/c insulins or accuchecks. Maybe would d/c meds like simvastatin etc but not cardiac, thyroid and such meds. Does patient want these d/c'd? That may be a different story.
Oct 18, '12
It is about the hospice goals that the patient and family have identified.
These are ethical issues that should be addressed by the IDT.
Oct 21, '12
I do not ask to dc any meds upon admission. for one, I don't know this pt. and to just dc them to me is unethical. To me that's like stopping the feedings just because they are on hospice.. Now, after doing a few visits and getting to know them and get a baseline, then I will discuss in IDT about dc'ing some of them, depending on what the pt or family wants. Most of the time, they want them to continue to take their meds as long as possible. I will explain the meds we cover and if they still want them to take the ones we do not cover, they will just continue to get them as they already are doing.
When the patient starts having difficulty swallowing, I help the family prioritize which ones to give first and eventually, they all have to stop most of the time except sl, pr or topical meds.
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