Evaluation of Subcutaneous Phenobarbital Administration in Hospice Patients.

Phenobarbital is used in hospice and palliative care to treat refractory symptoms. In end-of-life care, Food and Drug Administration approved routes of administration may be unreasonable based on patients' status. In these cases, phenobarbital may be administered subcutaneously for symptom management.

Medication appropriateness at end of life: a new tool for balancing medicine and communication for optimal outcomes--the BUILD model.

The BUILD model was created to provide a systematic framework for hospice clinicians to have important conversations with patients and families as well as facilitating useful conversations with interdisciplinary teammates. Although this article focuses on medication appropriateness and discontinuation of medications, this model can also be used when discussing prognosis, code status, goals of care, drug diversion, and when collaborating to develop a plan of care. When provided with a communication tool that is versatile, logical, and effective, hospice clinicians may use it, supporting improved patient care outcomes.

Petroleum jelly (vaseline balls) for the treatment of constipation: a survey of hospice and palliative care practitioners.

Constipation is a common symptom at end of life, impacting patient outcomes and healthcare costs. Hospice and palliative care professionals often use practices based on anecdotal evidence. One such intervention is an oral preparation of petroleum jelly (OPJ), referred to as "Vaseline balls.

Medication costs across the hospice stay: an evaluation of medication costs in response to the MedPAC proposed reimbursement model.

The Medicare Payment Advisory Committee (MedPAC) recommended that the per diem reimbursement for the Medicare Hospice Benefit change to a U-shaped scheme reflecting spending based on nursing visit frequency. This study investigated the change in drug cost over patients' length of stay (LOS) as current drug cost trends are unknown and were not evaluated in the MedPAC proposed reimbursement scheme. An analysis of patient utilizers of a national pharmacy claims database from 2007 to 2010 was completed to determine the trend in average daily pharmaceutical cost per utilizer (PCPU) over the patient's LOS.

Evaluation of atropine 1% ophthalmic solution administered sublingually for the management of terminal respiratory secretions.

Terminal respiratory secretions (TRS) or "death rattle" is a common symptom in the dying patient. Current practice for the prevention and treatment of TRS involves the use of oral, sublingual, transdermal, or parenteral anticholinergic medications. A retrospective chart review of patients admitted to a hospice inpatient unit for terminal care and treated with sublingual atropine 1% ophthalmic drops for TRS was conducted.