One of the most common myths we hear is “hospice care takes away all your medicines!” This couldn’t be farther from the truth! When a patient is enrolled in hospice care, a review of their medications is one of the first things we do. This review ensures the patient is receiving the best combination of medications to control symptoms and help the patient reach his/her goals.
What does it mean to be overprescribed?
When a patient reaches that “terminal” stage of their serious illness, they have been receiving treatment for many components of their serious illness for a while. In traditional medicine, with each new symptom or diagnosis or physician, a variety of new prescriptions are given. At times, this occurs without the physician being aware of medications that are already being taken, which can lead to the patient taking multiple medications that do the same thing or a combination being prescribed that have adverse reactions. Meaning the patient can be taking the same medication in different dosages or one medication is designed to help control swelling while another causes it!
This article from American Family Physician states “Adverse drug events occur in 15% or more of older patients presenting to [doctor] offices, hospitals, and extended care facilities.” This is roughly 1 in every 6 patients, which is 4x more than younger patients! Also, 1 in 6 older patients experiences an adverse drug event while in the hospital.
St. Anthony’s Hospice performs a thorough medication review of all patients prescription and non-prescription medications. We do this by taking stock of all prescriptions the patient is taking and adjust them, add prescriptions, and subtract prescriptions as needed.
Goals of Care
Anytime a patient’s goals of care change, a medication review should be done. When a seriously ill patient shifts their goals to comfort care rather than curative care, it is natural that some medications are not longer applicable to the patient. For example, oral chemotherapy drugs are no longer beneficial to a hospice patient or some long-term cholesterol medications may no longer be necessary for quality of life. But other medications such as those that help stabilize blood sugar may continue. The patient’s interdisciplinary team works together with the St. Anthony’s Hospice medical directors and the patient’s primary care physician to design a care plan tailored to that patient’s specific needs.
Most importantly, the top goals of hospice care are quality of life and controlling pain and symptoms associated with the patient’s serious illness. There will be new medications prescribed to help meet the goals of hospice care. Prescription medications should be expected to change as the patient’s condition changes. For example, if a patient can no longer swallow, prescriptions will change from a pill to a liquid or may be discontinued altogether (if the medication no longer helps the patient achieve his/her goals).
The patient’s interdisciplinary team educates the family and caregiver not only on the disease process, but the medications prescribed to the patient and how to administer them. Medications related to the patient’s hospice diagnosis, durable medical equipment, and medical supplies are covered under the hospice Medicare benefit. This does not include over the counter medications such as Tylenol, etc. If you have any questions about whether or not a prescription medication is covered under the patient’s hospice benefit, call us at (270) 826-2326 and we can help you.
If you or a loved one is in need of hospice or palliative care, please call us at (270) 826-2326 or make a referral here.
