Introduction: Understanding Deprescribing in Hospice Care
I know how important it is to provide comfort and support during this challenging journey. One aspect of hospice care that often raises concerns is deprescribing medications. In this article, we'll explore what deprescribing is and why it can benefit patients nearing the end of life.
What is Deprescribing?
Deprescribing is the process of thoughtfully and carefully reducing or discontinuing medications that may no longer be necessary or could potentially cause harm as patients reach the end of life. It involves a collaborative effort between healthcare providers, patients, and families to ensure the best possible quality of life during this time.
Addressing Concerns About Stopping Medications
It's normal for patients and their families to have concerns about stopping medications previously deemed essential for managing their health conditions. You may wonder if these medications keep the patient alive or provide significant benefits. Let's address some common concerns:
Statin Medications: Statins are often prescribed to manage cholesterol levels and reduce the risk of heart disease by an absolute risk reduction of less than one percent! While they may have been beneficial during the earlier stages of the disease, their benefits may not be as relevant in the terminal phase. Additionally, statins can cause side effects that impact comfort.
Medications for Dementia: Drugs like donepezil and memantine improve cognitive function in early to mid-stage dementia. However, in the terminal stages of dementia, these medications may not offer significant benefits, and they could even cause adverse effects or discomfort.
Feeling Guilty: It's not uncommon for families to feel guilty about stopping certain medications. Please know that deprescribing decisions are made with the patient's best interest at heart, aiming to provide comfort and improve the quality of life.
The Beers Criteria: Identifying Inappropriate Medications
The Beers Criteria is a valuable resource that provides guidelines on potentially inappropriate medications for older adults. It helps healthcare providers, including hospice nurses, evaluate medications that may no longer be suitable in the terminal phase of life. Here are some key points to consider:
The Beers Criteria identifies medications that may cause harm or have limited benefits in older adults, especially those with multiple health conditions.
Deprescribing based on the Beers Criteria can reduce the risk of adverse drug reactions and improve overall well-being.
Discussing deprescribing with patients and families is crucial. Engaging in open conversations, addressing their concerns, and explaining the rationale behind each decision is essential.
The STOPP and START Criteria: Another Tool to Guide Informed Decisions
STOPP (Screening Tool for Older Persons' Prescriptions) and START (Screening Tool to Alert to the Right Treatment) criteria are valuable tools that can help us make informed decisions about medication management in hospice care.
Understanding STOPP and START Criteria
STOPP criteria are designed to identify potentially inappropriate medications that may need to be stopped or deprescribed in older adults. On the other hand, START criteria help healthcare providers identify medications that should be initiated when necessary.
Applying STOPP Criteria in Hospice
Stopping Unnecessary Medications
Medications Without Indication: STOPP criteria can help us identify and discontinue medicines that no longer serve a purpose or provide benefits in terminal illness. This includes medications that were prescribed for conditions that are no longer relevant.
Medications with a High Risk of Adverse Effects: Minimizing therisk of adverse effects is essential in hospice care. STOPP criteria can guide us in stopping medicines with a high potential for harm or discomfort, significantly when the benefits no longer outweigh the risks.
Drug-Drug Interactions: Patients in hospice often take multiple medications. STOPP criteria can help us identify potential interactions between drugs, allowing us to deprescribe those that could lead to adverse outcomes.
Utilizing START Criteria in Hospice
Initiating Necessary Medications
Symptom Management: START criteria can assist us in identifying medications that should be initiated to manage specific symptoms common in hospice patients, such as pain, anxiety, or nausea. This ensures that patients receive appropriate relief when needed.
Preventing Common Conditions: In some cases, initiating medications to avoid common complications in hospice, such as pressure ulcers or infections, may be necessary. START criteria can guide us in making these decisions to enhance patient comfort.
Incorporating STOPP and START criteria into hospice care allows us to provide more personalized and patient-centered medication management. By deprescribing unnecessary medications and initiating essential ones, we can improve the overall quality of life for terminally ill patients while minimizing potential harm.
The Benefits of Deprescribing in Hospice
Now, let's dive into why deprescribing can be so beneficial for patients nearing the end of life:
Enhanced Comfort: Reducing the number of medications minimizes potential side effects, drug interactions, and unnecessary treatments, leading to improved comfort and well-being.
Improved Clarity: Patients taking fewer medications may feel more alert and present, fostering meaningful connections with loved ones in their final days.
Better Symptom Management: Deprescribing allows us to focus on symptom management for comfort rather than managing multiple medications.
Reduced Burden: Patients may feel overwhelmed by the number of medications they take. Deprescribing can lessen the burden of medication management, making their final days more manageable.
Respect for Patient Wishes: Deprescribing aligns with the philosophy of hospice care, which aims to honor patients' wishes and provide person-centered, compassionate support.
Conclusion: Embracing the Journey Together
As a hospice nurse, I understand the complexity of deprescribing decisions. It's essential to remember that each step we take is guided by the desire to offer the best possible care and support for our patients and their families. Embracing this journey together, we can create an environment of comfort, love, and understanding.
If you have any questions or concerns about deprescribing, please don't hesitate to contact your hospice care team. We're here for you every step of the way.
