文档介绍：Evergreen Hospice Rotation
Ted Williams
PharmD Candidate 2009
PHAR 744
About the Tie
Yes, I wear a bow tie to work
Yes, I wore a bow tie to my rotations
No, it is not a clip on, I tie them myself every time
My sister got this for me for Christmas
Outline
What is Hospice
Pharmacy role in hospice
Case Study
What is Hospice
Palliative care for terminally ill patients
Must have a terminal diagnosis with <6mo life expectancy
Must demonstrate gradual decline
Evaluation period of 90 days
Economics of Hospice
Medicare Part B
Flat rate for all care services and medications
Care in Hospice
Counseling Services
Patient
Familiy
Medication Management
More e
Direct Care Services
Set up and maintenance of durable medical equipment
Medication administration
Bathing and feeding
General nursing care
Pharmacy in Hospice
Discontinuation of most maintenance meds
Hypertension
Thyroid
Osteoporosis
Life sustaining meds like insulin are continued
Introduce and/or continue pain management medications
Opioids
Steroidal and non-steroidal anti-inflammatory meds
Special Considerations for Pharmacy Management
Long term side effects are of little consequence
Short to mid term side effects are an issue
Nausea/Vomiting
. opioids
Constipation/Diarrhea
. opioids
Desensitization
. Steroids
Case Presentation
Subjective
Patient: OM
Age: early 60s
PMH
Long history of minor CVD
Long history of minor CVA
5 months prior to visit patient had a massive CVA
Massive CVA
3 months a UCSF MC
Several weeks at skilled care facility in Vancouver, WA
Several weeks at home under Hospice Care
Patient is atose and generally unresponsive, but does visually track and has some limited reactions