Clinician Checklist for Actively Dying Patients

  • Establish and maintain a peaceful environment.
  • Notify and educate family about the possibility or probability of impending death.
  • Review medications and other therapeutic interventions in light of the change in the patient’s status. Are all the medicines being administered still necessary? Generally speaking, opioids and anticonvulsant medications should be continued, if possible.
  • Adjust medication routes, as the ability to swallow is likely to be lost.
  • Consider adding a low opioid dose or increasing basal opioid by 25% if dyspnea is present or probable.
  • If the patient becomes anxious, provide an anxiolytic. If delirious, treat as described in the section on delirium in Chapter 7 of Palliative Care Perspectives by James Hallenbeck.
  • Consider giving oxygen via nasal prongs or using a gentle fan.
  • If respiratory secretions become troublesome, consider using anticholinergic agents to dry them. Scopolamine (0.4 mg. S.C. q 4-6 h prn secretions) is very effective. Scopolamine is highly sedating, which is often advantageous at this stage. Atropine eye drops 1% (1-2 drops q1-2 h as needed) are often used in home hospice settings, where subcutaneous administration is difficult. Atropine is less sedating than scopolamine and can overtly worsen delirium. An alternative agent, glycopyrrolate (1 mg PO or 0.1 mg parenterally TID), can be administered if one wishes to avoid sedation and delirium (as glycopyrrolate does not significantly pass the blood-brain barrier). Anticholinergic agents are likely to be more helpful if given early, as they prevent the production of secretions and do not remove existing secretions. If hydration via IV or PEG tube is being given, discuss discontinuation as further hydration may contribute to respiratory secretions.
  • Occasionally, mouth suctioning of secretions can be helpful. Usually, deep suctioning is ineffective and unhelpful.
  • Coach the family on the changes that are occurring.

Source: Palliative Care Perspectives by James Hallenbeck

By | 2018-01-04T21:03:22+00:00 December 1st, 2015|Pharmacist Corner|0 Comments

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