palliative meds

Kissy1818 · Dec 25, 2014

I work in the uk and as a protocol for end of life agitation they uae midazolam prn and in syringe driver. Seems everywhere has different protocols. Just getting ny head round thw whole end of life thing, find it difficult sedating patients even when agitated as I wonder what affect it has on them and their family.

chopwood carrywater · Dec 26, 2014

I work in the uk and as a protocol for end of life agitation they uae midazolam prn and in syringe driver. Seems everywhere has different protocols. Just getting ny head round thw whole end of life thing, find it difficult sedating patients even when agitated as I wonder what affect it has on them and their family.

The agitation is also going to have an effect on pt and family.

What is the thing that you find difficult about EOL sedation?

I don't think everyone should be sedated at EOL but there are times when it seems like it's the right thing to do unless the pt has specifically designated otherwise.

Kissy1818 · Dec 26, 2014

I think its that I fear the patient may miss out on last words with family but I suppose if they are agitated it is much more destressing. And benzos have the same risks as opiates of respiratory depression. I think its Being new to this area of nursing.

ktwlpn, LPN · Dec 26, 2014

I think its that I fear the patient may miss out on last words with family but I suppose if they are agitated it is much more destressing. And benzos have the same risks as opiates of respiratory depression. I think its Being new to this area of nursing.

It might help for you to keep reminding yourself it's not about your fears,feelings,thoughts.Each family(in an ideal situation) has been given the tools they need by the team.How they use them through the journey is up to them.That has been the most difficult aspect of EOL care for me,I have struggled.Now I am at a place where I don't internalize or view situations as "win or loose".I give the info,if the family wants to flog their 94 yr old dying patriarch (full code!) I have to accept it.

Pondmud · Dec 26, 2014

While there is validity to sedating an agitated person as a means to provide comfort, I think medicating someone with the primary goal of sedating (as opposed to relief of something else that brings a sedative side effect) them requires deliberation. Is this really what the patient wants? I've known plenty who have traded pain relief for consciousness because they would rather have 6/10 pain and see their children as much as they can, versus being at 2/10 and miss out on everything, forever.

That said, there are also a small proportion of people who just can't tolerate the distress of EOL, and ask, as one daughter put it, to "go to sleep". Yes, it is their stated wish - but as clinicians, we have to be absolutely sure that's what they really want.

Kissy1818 · Dec 26, 2014

In this occasion that distressed me the most the gentleman wasquite young, deteriorated quickly each time the midazolam wore off he was quite agitated trying to get out of bed, was this due to his illness or the meds? Maybe I will never know

Red Kryptonite · Dec 26, 2014

Sounds like terminal restlessness to me.

KelRN215, BSN, RN · Dec 29, 2014

In this occasion that distressed me the most the gentleman wasquite young, deteriorated quickly each time the midazolam wore off he was quite agitated trying to get out of bed, was this due to his illness or the meds? Maybe I will never know

He needs better symptom management, should be on a drip.

Kissy1818 · Dec 29, 2014

I think in hindsight I would agree.

wanderlustnurse88, RN · May 8, 2015

I just did a versed drip on one of my palliative pts today. Pt was on sc Ativan but our doctor talked with a palliative care doc (we are a small town hospital) and the suggestion was versed 3mg/h and titrate up to a max of 6mg/h and if still restless then add nozolin (which we don't even stock). I've seen versed used once before with an agitated palliative care pt.