As an experienced hospice nurse, I understand the challenges that terminally ill patients and their families face. One of the biggest challenges is managing symptoms such as pain, anxiety, and nausea. Hospice comfort medications can help provide relief and improve the quality of life for patients in their final days. This article will discuss some of the most used hospice comfort medications and when they might be used for comfort.
Before we start, please understand that none of the medications used by hospice are euthanizing medications. One of the primary goals of hospice is comfort at end-of-life and NOT making your loved one die faster.
Morphine
Morphine, which comes in pills or liquid form, is commonly used to treat pain and shortness of breath by easing the sensation of breathlessness and restlessness. It has mild fever-reducing properties and is a mild cough suppressant.
Common side effects of morphine include constipation and sedation/drowsiness. Uncommon side effects include itching, nausea with or without vomiting (this typically goes away in a few days and can be managed by anti-nausea medication), and hallucinations. It is important to note that hospice professionals can manage these side effects with proper dosing and monitoring.
If your loved one is experiencing significant pain or difficulty breathing, morphine may be recommended as a hospice comfort medication. It is typically administered as a liquid or tablet, and the dosage is carefully monitored to ensure the patient receives the appropriate amount of pain relief. The maximum daily dose of morphine is 1,600 mg, which is exceedingly difficult to reach considering a full 1 mL syringe of morphine is 20 mg and a single 30 mL bottle of morphine contains 600 mg of morphine. Common starting dosing of morphine ranges from 0.25 mL (5 mg) to 0.5 mL (10 mg) every two hours as needed for pain, but it is not uncommon to have patients be given 1.0 mL (20 mg) every hour as needed.
Lorazepam
Lorazepam comes in pill or liquid form and is used to treat anxiety, shortness of breath, and restlessness. It can also be used to treat insomnia and attempt to prevent or minimize seizures.
Common side effects of Lorazepam include constipation, sedation, and drowsiness.
If your loved one is experiencing anxiety, restlessness, or agitation, lorazepam may be recommended as a hospice comfort medication. It is typically administered as a liquid or tablet, and the dosage is carefully monitored to ensure the patient receives the appropriate amount of anxiety relief. The maximum daily dose of lorazepam is 10 mg. Common dosing ranges from 0.25 mL (0.5 mg) to 0.50 mL (1.0 mg) every four to six hours as needed.
Other Common Hospice Comfort Medications
In addition to morphine and lorazepam, several other hospice comfort medications may be used to manage symptoms such as pain, nausea, and delirium. Some of these medications include:
Acetaminophen (Tylenol): This medication can help reduce pain and fever in hospice patients. The maximum daily dose is 3,000 mg, with the most common dose of 500 mg tablets. For mild pain or fever greater than one hundred degrees Fahrenheit, take two tablets every eight hours.
Atropine: This medication can help dry up secretions in the mouth and throat, which can be common in patients nearing the end of their lives. As this medication is typically used in the last 24 to 72 hours of life, there’s typically no concern for a maximum dose; the common use is one to two drops under the tongue every hour as needed for the gargling/gurgling/rattling that can occur at the end of life.
Haloperidol (Haldol): This medication can help manage delirium, agitation, psychosis, and hallucinations at the end of life. The maximum daily dose is 30 mg. The most common dose is 0.5 ml (1 mg) every 6 hours as needed.
Hyoscyamine (Levsin). Like Atropine, this medication can help dry up secretions in the mouth and throat, which can be common in patients nearing the end of their lives. As this medication is typically used in the last 24 to 72 hours of life, there’s typically no concern for a maximum dose; the common dose is one tablet under the tongue every two to four hours as needed.
Ondansetron (Zofran): This medication can help manage nausea and vomiting. The maximum daily dose is 24 mg, but the most common dose is 4 mg every 4 hours as needed.
Prochlorperazine (Compazine): This medication can help manage nausea and vomiting during the end-of-life journey. The maximum daily dose is 40 mg, but the most common dose is 10 mg every 6 hours as needed.
It is important to note that each patient is unique, and their symptoms may require different medications or dosages. Also important is that hospice agencies are unique, and what one hospice agency uses for “comfort medications” may vary from hospice to hospice.
Hospice professionals will carefully assess the patient’s symptoms and recommend the appropriate hospice comfort medications based on the individual needs of your loved one.
Using Comfort Medications Safely
While hospice comfort medications can be highly effective in managing symptoms and providing comfort to patients, it is vital to use them safely. Here are some tips for using comfort medications:
Work closely with a hospice team: Hospice care is a team effort, and it is crucial to work closely with a hospice team to manage medications and ensure that patients receive the right medication dose for their needs.
Journal what comfort medications you give and approximately when they were given.
Monitor for side effects: Comfort medications can cause side effects, so it is essential to monitor patients closely for any signs of drowsiness, confusion, or other side effects. If you or your loved one notices side effects, 1) call your provider immediately if the side effects are distressing or otherwise scary, and 2) please journal the experience.
Store medications safely: Comfort medications should be stored in a safe and secure location that is out of reach of children, pets, and visitors.
Dispose of medications properly: When comfort medications are no longer needed, they should be disposed of properly. Talk to your hospice team about how to dispose of medications safely.
Benefits of Hospice Comfort Medications
Hospice comfort medications can provide a range of benefits to patients and families, including:
Relieving pain and other symptoms: Medications such as morphine can help manage pain, while medications such as lorazepam can help manage anxiety and agitation.
Improving quality of life: By managing symptoms, hospice comfort medications can help improve a patient’s overall quality of life, allowing them to enjoy time with loved ones and engage in meaningful activities.
Increased sense of control: By managing symptoms effectively, patients may feel more in control of their situation and more able to focus on what matters most.
Reducing stress for families: Hospice comfort medications can help ease the burden on families who may be struggling to manage their loved one’s symptoms on their own.
Better sleep: By managing symptoms such as pain, anxiety, and nausea, patients may be able to sleep better, which can have a positive impact on overall well-being.
What Families and Loved Ones Should Know
It is understandable for families and loved ones to feel hesitant or uncomfortable with the idea of hospice comfort medications. However, it is important to understand that these medications are designed to provide relief and improve the quality of life for patients in their final days.
Here are some essential things to keep in mind:
Hospice comfort medications are carefully monitored and administered by hospice professionals. A doctor with prescribing privileges is always involved. Most hospice agencies have a hospice pharmacy that reviews your loved one’s allergies and the interactions of each medication your loved one is taking or might take based on what’s available in the home within the knowledge of the hospice agency.
None of the comfort medications are euthanizing agents. Hospice professionals are present to provide comfort, encouragement, and support, not speed up the dying process.
Side effects are carefully managed to ensure the patient’s comfort. You can help by bringing any side effects you notice to your hospice team.
Hospice care aims to provide comfort and improve the quality of life for the patient and their loved ones.
It is also important to talk to your loved one’s hospice team about any concerns or questions. They can provide guidance and support as you navigate this challenging time.
Conclusion
In conclusion, hospice comfort medications can provide significant relief for terminally ill patients. Morphine and lorazepam are two of the most commonly used hospice comfort medications, but several others may be recommended based on the patient’s individual needs. If you have any questions or concerns about hospice comfort medications, you should speak with your hospice care team for guidance and support.
