Pearls for Better End-of-Life Care | Pharmacy QI | May 2020
May 2020 | Practical Tips for Quality Improvement | View PDF
- DISCUSS GOALS OF CARE
Ensure the resident or their substitute decision maker understands the serious nature of their illness, and set up goals for their care that meet their needs and values.
- OPTIMIZE THERAPY
- Subcutaneous is the preferred route of medication administration.
- For residents NOT already taking opioids (opioid-naïve):
- Start with low PRN dosing.
- Advance to Q4-6H scheduled dosing if more than 6 PRN doses/24 hours.
- For residents already taking opioids:
- Consider switching to subcutaneous route. (dose = 1/2 PO dose)
- Consider increasing current dose by 25%.
- For breakthrough pain:
- Start opioid PRN at 10% of total daily dose.
- Consider the need for supplemental oxygen.
- Consider discontinuing all nonessential medications. Your Consultant Pharmacist can provide recommendations for deprescribing.
- PROVIDE GRIEF AND BEREAVEMENT SUPPORT
- Consider involving the social worker, spiritual care advisor, or another trained clinician to provide support.
- Mobilize virtual support in cases of outbreak.
Suggested Tools to Assist with Difficult COVID-19-related Conversations
- COVID-19 Conversation Tips (http://bit.ly/SeattleVitalTalkCOVID19)
- Serious Illness Conversation Guide (http://bit.ly/SeriousIllnessConversationGuide)
1. Ontario Palliative Care Network. Approaches to goals of care discussions.
https://www.ontariopalliativecarenetwork.ca/sites/opcn/files/ApproachesToGoalsOfCare.pdf. Accessed April 3, 2020.
2. McAleer K et al. Symptom management for adult patients with COVID-19 receiving end-of-life supportive care outside of the ICU. Adapted from BC Centre for Palliative Care Guidelines.
March 2020. https://bc-cpc.ca/cpc/wp-content/uploads/2020/03/COVID-19-End-of-Life-Symptom-Management.pdf. Accessed April 3, 2020.