The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Dec 2013
Factors associated with advance care planning discussions by area agency on aging care managers.
Initiating advance care planning (ACP) discussions in the home may prevent avoidable hospitalizations by elucidating goals of care. Area agencies on aging care managers (AAACMs) work in the home with high-risk consumers. ⋯ It may be necessary to build interactive educational experiences where, for example, AAACMs are asked to fill out their own advance directives and/or facilitate others in ACP discussions to improve experience and comfort with ACP discussions.
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Am J Hosp Palliat Care · Dec 2013
Case ReportsInadvertent ophthalmic administration of atropine drops in a hospice patient.
This case report describes a patient who had atropine ophthalmic drops prescribed and dispensed by hospice to be administered sublingually as needed for control of secretions at the end of life. However, even as she stabilized and discharged from hospice, these remained on her medication list. ⋯ The patient experienced severe blurring of vision until the error was corrected. This case highlights the potential risks of the common practice in hospice of using alternate routes of administration for medications designed for another purpose.
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Am J Hosp Palliat Care · Dec 2013
Intermittent subcutaneous furosemide: parenteral diuretic rescue for hospice patients with congestive heart failure resistant to oral diuretic.
Patients with congestive heart failure (CHF) account for up to 12% of the hospice population and often experience significant symptoms related to volume overload. Diuretic therapy is the cornerstone of treatment but administration (PO) often becomes ineffective and (i.v., i.m.) routes cause discomfort or may not be feasible to ameliorate symptoms. ⋯ We report 2 cases of CHF resistant to oral diuretic and examine the clinical utility of subcutaneous furosemide in an inpatient palliative care unit and a home hospice setting. Our case series supports the use of subcutaneous therapy as a potential alternative in palliative care and hospice patients.
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Palliative sedation (PS) is a treatment option in case of refractory symptoms at the end of life. The emotional impact on nurses and doctors has been widely studied. We explore the experience of family members during a PS procedure. ⋯ Palliative sedation should be performed in the best possible way for the patient and his family in order to efficiently reduce a refractory symptom.