Hospice symptom management medication list

I am going back to work with hospice next week. I have worked hospice before, both home and IPU but it has been a few years. I will be in an IPU with this position. I was curious whether or not anyone could share a medication list for standard orders for symptom management. I'm sure it will come back to me after a while, but would appreciate any resources! Thanks

[ktwlpn, LPN]

Our basic orders are as follows-mso4 5mg q 1 hour prn,lorazepam 0.5mg q4 prn,atropine ophthalmic drops-two gets q1 hour prn,Tylenol suppository prn.Then we adjust from there,when they enter the dying trajectory we start scheduling them around the clock.Bowel meds (lax/softener),sometimes transdermal scope patch,too

[toomuchbaloney]

I'm thinking you might get more responses if this were moved to the HOSPICE forum.

[nrsang97, BSN, RN]

We commonly use ativan, scop patches, morphine, dilaudid (if allergic to morphine), rubinol (glycopyrolate), atropine, roxanol, and other standard comfort orders.

[ShesanRN]

Our standard comfort med orders are for sublingual Roxanol, Ativan and atropine drops every 2 hours as needed and Tylenol and phenergan suppositories prn. We adjust and substitute from there with Oxy IR, Xanax, haldol, scopolamine patches, Robinul, compazine and CADD pumps as well.

[SierraBravo]

Our basic orders are as follows-mso4 5mg q 1 hour prn,lorazepam 0.5mg q4 prn,atropine ophthalmic drops-two gets q1 hour prn,Tylenol suppository prn.Then we adjust from there,when they enter the dying trajectory we start scheduling them around the clock.Bowel meds (lax/softener),sometimes transdermal scope patch,too

Don't take this the wrong way, but it's one of my pet peeves when someone uses the abbreviation mso4. I know you meant morphine sulfate, but it's easy for someone looking at it quickly to interpret it as magnesium sulfate. In my facility, there are a number of abbreviations that are not acceptable to use and mso4 is one of them because of the high potential of misinterpretation.

[Red Kryptonite]

Actually I think mso4 has been banned by the Joint Commission, not just your facility.

[Jack Hazz, BSN, RN]

I work with the biggest hospice company in the US and normally our admission nurses start the patients with roxanol 20mg/ml (the usual 0.25ml for mild, 0.5ml for mod, and 1ml for severe pain/sob) q2, ativan 1mg q4 PRN, levsin (personally, I hate it and when I do my initial visit, I usually change it to atropine), O2 (of course), senna, and/or colace, acephen supp and/or acetaminophen for fever. I use dilaudid if they are allergic to morphine or if our MD allows it, fentanyl patch, especially for those that can no longer swallow but still have enough body fat.

We also supply all DMEs...we have our own DME department now, which is a lot easier than calling DME companies like Apria.

And of course, sometimes, the family refuses to d/c some or all of pt's medicines so we have to honor that.

Hope that helps and welcome to hospice!

[Red Kryptonite]

Your own DME dept? That sounds awesome. Is it saving your agency money? How are you handling storage? I'm intrigued.

[blondebabe0625]

Depends their level on the hospice... Last stages atropine drops, Ativan & morphine

[Jack Hazz, BSN, RN]

I dont know about savings on the DMEs...I am not management but I would assume so. But it is a lot easier to request equipments like beds and mattresses, table, commodes, high back or reg w/c, o2 tanks and concentrators...heck, even walkers. And they usually deliver it within 24 hrs depending on when you placed an order (we call our orders in to our team secretaries and they do the rest). I don't know what you mean by storage, but if you were asking about where they store all those, our DME dept have their own office and warehouse plus storage units and trucks...so there.

[lifelearningrn, BSN, RN]

We have an awesome DME company that are on call 24/7 and usually have DME delivered in a matter of a couple of hours. It sounds like IPU units use the same meds that we use in the home.