resources for hospice medications?

[texasRN_14]

Hello all, I am a new nurse to hospice and am just wondering if there are any resources out there about how medications are used differently (aka high/more frequent doses of morphine) and 'off-label' (aka haldol as an anti-emetic) for end of life care.

I am going to be in crisis care (continuous care) and want to be able to have to knowledge to understand what and why my patients are taking what they are taking and what changes to their medications I can suggest to the doctor if their current regimen isn't working, specifically for nausea and things like terminal restlessness/agitation.

All of the nurses I have shadowed just have so much knowledge in regards to the medications, and while I know some of that experience just comes with time, I would love to be able to have something to look at for reference when I am on my own.

Thanks!

[PamRNinTX]

If you are a continuous care LVN, you will have an RN who manages the plan of care, likely including medications and med orders. You should receive training from your employer regarding the different meds used in Hospice. Also, you can request additional education from the RN case manager when he/she visits the patient; the RN should also be educating patient and family on the meds and hopefully you will be able to listen to that education.

[SuesquatchRN, BSN, RN]

Notes on Symptom Control in Hospice & Palliative Care: Peter Kaye: 9780962343810: Amazon.com: Books Expensive, though.

There's nothing specific to medication. Download the free version of Epocrates to your phone.

[texasRN_14]

Thank you both. I am still in training, I am just adjusting to the new way that medications are prescribed and given in hospice. I will be with the patient and family during a crisis and don't want to mess up or cause the pt more discomfort because I'm not sure why the med isn't working or what would be a better alternative. I guess I'll just ask more questions during my shadows and call my supervisor or Dr when in doubt when I'm on my own.

[babyjRN]

I received a small book titled "The Hospice And Palliative Care Symptom Management Handbook". My employer gave it to me but you may be able to purchase it on Amazon.

[nursekiddo]

Once you are in the field awhile, you'll learn the tools of the trade. Comfort medications are usually the same across the board: Roxanol or MSIR, Lorazepam and/or Haldol, atropine. You'll have a dose you start out with, you observe how it works, and then you go up or down from there. Titrating comfort meds is a lot of trial and error. If you're like me, you'll probably be overly cautious at first and pretty conservative with the meds. Once you get the hang of it, you will be able to walk into a case, take one look at the patient, and call the doc and tell them exactly what you need. It just takes practice. The hardest part, especially coming from other areas of healthcare, is wrapping your mind around the normalcy of giving what seems like crazy amounts of morphine.

Oh, and a helpful hint: Remember to pay attention to ALL non verbal signs of pain. If a patient is "moaning", but their face is relaxed, their breathing is not labored, and their posture is not tense, they may just be noisy breathers. Some "moaning", especially if it's on exhalation, is just how it's going to be for that patient.

[Alvindudley]

Joining hpna can be a huge help.