Pain Relief in Hospice

[nursing_newbie]

Quick question about pain relief in hospice and end-of-life care. If a pt has been managing pain on hospice with oral morphine and eventually loses appetite or swallow enough to no longer tolerate PO intake, what is the typical standard of practice for pain control? IV insertion? Interested in hearing stories & opinions. Thanks!

[mi_dreamin, BSN]

If not in a pain crisis pt can switch to SL meds, oxycodone and morphine are often given sublingually in patients who cannot swallow, unconscious patients included.

The provider may also add a fentanyl patch for continuous release of pain medication.

SL meds are absorbed through the mucous membranes and usually work faster than PO and last longer than IV.

FWIW, this is based on my experience with inpatient hospice care.

[Lucydog14]

I used to work in a residential hospice. Almost all of our residents had PCA pumps. Otherwise they had subcutaneous ports.

[lucyvanpelt]

I work for a hospice where we go to the pts home whether that be private residence/ALF/SNF. Our patients are provided a symptom relief kit on admission with liquid OMS, haldol and lorazepam that can be given sublingually/buccal. When necessary the md will sometimes order for the liquid medication PR. In a true crisis with need for palliative sedation we give phenobarbital PR. We occasionally use pumps via subq port. Due to a high number of our pts being at private homes we do not usually do IVs since its hard to manage those at home.