The American journal of hospice & palliative care
-
Am J Hosp Palliat Care · Jun 2013
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. ⋯ This study suggests that atropine 1% ophthalmic drops administered sublingually are a reasonable option for the management of TRS. Problematic cardiac or central nervous system symptoms were not found in the present study. Results should aid hospice programs who are seeking guidance on the management of TRS with atropine 1% ophthalmic drops.
-
Am J Hosp Palliat Care · Jun 2013
Factors considered in end-of-life care decision making by health care professionals.
To explore the importance of factors influencing the end-of-life care decision making of health care professionals (HCPs) in Singapore. ⋯ End-of-life care decision making by HCPs appears largely patient centered, although familial determination still wields significant influence with implications for advance care planning.
-
Am J Hosp Palliat Care · Jun 2013
Referral patterns of nonmalignant patients to an Irish specialist palliative medicine service: a retrospective review.
Our perception is that the proportion of referrals made to the specialist palliative medicine service (SPMS) in our institution for patients with a primary diagnosis of nonmalignant disease is high and that these patients are often referred late in their illness. We aimed to review the symptom burden and referral patterns of patients with a noncancer diagnosis to the SPMS in our centre. ⋯ The proportion of noncancer patients referred to the SPMS is our institution is high. This study confirms that nonmalignant referrals are commonly sent to the SPMS when patients are actively dying or very imminently dying. Further education of colleagues is warranted in the role of the SPMS, particularly with regard to earlier referral.
-
Am J Hosp Palliat Care · Jun 2013
The impact of a palliative care program in a rural Appalachian community hospital: a quality improvement process.
Hospital inpatient palliative care consultation services (PCCSs) provide high-quality, comprehensive care for seriously ill patients and their families. The objective of the Palliative Care Impact Study was to evaluate the impact of a PCCS in a rural Appalachian community hospital in 4 domains: clinical, customer, operational, and financial. ⋯ A nonrandomized preintervention-postintervention study enrolled 25 patients. We collected data in the 4 domains listed above after a palliative care (PC) consultation and compared them with preconsultation data. Findings demonstrated a statistically significant improvement in pain and symptom burden scores; customer metrics produced an excellent rating of 88.5% by patients and families and physician/providers; with an associated cost savings of $521 per patient per day after PC consultation was complete.
-
Am J Hosp Palliat Care · Jun 2013
Prevalence of methicillin-resistant Staphylococcus aureus colonization and infection in hospitalized palliative care patients with cancer.
Little is known about the pattern of methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in hospitalized palliative care (PC) patients. We reviewed 854 admissions for 289 patients with advanced cancer managed by a PC service in a tertiary care hospital. The MRSA screening was performed at least once in 228 (79%) patients, and 21 (9%) of them were MRSA positive. ⋯ The total number of MRSA-positive admissions was 28 (3%), with a median admission duration of 8 days. A substantial proportion of hospitalized PC patients with cancer are MRSA positive. Research is required to study the impact of infection control measures on the quality of PC delivered to MRSA-positive terminally ill patients in hospitals.