Articles: palliative-care.
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Background: Since the onset of the COVID-19 pandemic, all facets of palliative care provision for patients with serious illness have faced unparalleled challenges. Methods: We describe our palliative care program's response to the increased clinical volume associated with the pandemic by adapting workflows for inpatient and outpatient palliative care teams caring for oncology and nononcology populations. ⋯ Discussion: This article highlights transformations in palliative care delivery implemented in response to the pandemic and reflects on how these transformations have shaped our current care delivery models. We further delineate our intentional reliance on key population health principles to drive ongoing innovation in palliative care provision across our clinical teams.
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Case Reports
Novel Use of Intranasal Dexmedetomidine for Refractory Irritability in Pediatric Home Care.
Background: Dexmedetomidine is a selective alpha-2 agonist with sedative, analgesic, and anxiolytic properties used intravenously for procedural sedation and in the intensive care unit. The reported use of intranasal (IN) dexmedetomidine for symptom management in pediatric palliative care is limited. Case History: A boy with cardiofaciocutaneous syndrome and refractory irritability was supported by pediatric palliative care throughout numerous hospitalizations for goals of care discussions and pain and symptom management. ⋯ After the addition of scheduled IN dexmedetomidine for management of irritability, the boy demonstrated marked improvement in comfort and sleep. Conclusion: This case report shows the successful use of IN dexmedetomidine for management of refractory irritability with no noted adverse effects. Future studies and use of this medication will need to consider potential indications, optimal dosing, and long-term effects in the pediatric palliative care setting.