How the New Regulations Change the Way You Care for Your Patients

Jan 2nd, 2018

The LTC MEGA Rule Part II is effective as of November 28, 2017. The overall goal of the new regulations is the safe and effective use of medications. ... read more


Medication Coverage in 2018

Dec 2nd, 2017

The 2018 Wage Index and Payment Rate Update for Hospice includes significant wording differences compared to the current Conditions of Participation. These differences may cause hospice agencies to feel that they now must cover more medications. The Wage Index wording reads: “…hospice t ... read more


Cold, Flu and Pneumonia Season

Nov 1st, 2017

It is that time of year again. The time of year when the cold weather drives everyone inside, where they huddle together with their electronic device of choice. They hack, sneeze, and cough passing the micro-organisms back and forth to one another until things warm up in April or May. There are two ... read more


Methadone

Oct 4th, 2017

Methadone has the ability to relieve a wide variety of pain types, is available in a “long acting” 10 mg/ml concentration, and it is low cost. All of these reasons make it an ideal analgesic for hospice. Many nurses and ... read more


New Governmental Alert and Regulation Warning!

Sep 1st, 2017

The Occupational Safety and Health Administration (OSHA) requires employers to inform employees how to identify the hazardous materials they may encounter in the workplace. However, many drugs are considered hazardous materials. If an emp ... read more


Floor Stock Medications

Aug 8th, 2017

Access to medications is one of the most important, if not the most important, concerns of a hospice nurse.This is especially true for patients admitted to inpatient care. Patients who are eligible for inpatient care are those most in need of medication at a  ... read more


Antibiotics and Dementia

Jul 1st, 2017

Pneumonia and other infections are a common complication of dementia. Often, pneumonia is listed as the cause of death rather than the dementia itself. The question comes with each infection – treat or not to treat? The answer to this question leads to another question. What is the ultimate ca ... read more


Anticoagulant Use in Hospice

Jun 1st, 2017

Whether it’s a child who cannot swallow pills or an Alzheimer’s patient who won’t, pharmacists all over the country and in every practice setting are asked “How can this medicine be made to taste better?” There are a few tips and tricks to help that medicine go down. Anticoagulants and ant ... read more


Inappropriate Drugs in Hospice Proton Pump Inhibitors

May 1st, 2017

While Proton Pump Inhibitors (PPIs) are generally considered safe, recent studies and FDA reports bring to light a number of risks in taking these “safe” medications—particularly in the elderly. The volume of PPIs reported to the Centers for Medicare & Medicaid Services (CMS) flagged this ... read more


Is There Any Way to Make it Taste Better?

Apr 20th, 2017

Whether it’s a child who cannot swallow pills or an Alzheimer’s patient who won’t, pharmacists all over the country and in every practice setting are asked “How can this medicine be made to taste better?” There are a few tips and tricks to help that medicine go down. First, ... read more


Medicare Part D Prior Authorization Procedure

Mar 1st, 2017

Hospices are required by Medicare to pay for drugs that treat nausea, vomiting, anxiety, pain, and constipation along with those that are related to terminal diagnoses. Every once in a while there may be a situation where the hospice and the patient’s Part D plan disagree on what should be covered ... read more


Prescription Writing Refresher

Feb 1st, 2017

HospiceMed is excited to introduce their e-prescribing system to all hospice agencies. The introduction is a good time to have a quick refresher on correct prescription writing. In the U.S., 1.3 million people are injured each year by medication-related errors. Of those injured, approximately 700 ... read more


E-Prescribing – A Perfect Tool for Hospice

Jan 2nd, 2017

Prescription writing has not changed in over 100 years. Doctors put pen to paper and scribble out something for the patient to take to the pharmacist to decipher and fill. The Institute of Medicine estimates there are approximately 1.5 million preventable adverse drug events (ADEs) each year, with 7 ... read more


PPD Clarity

Dec 1st, 2016

What exactly does PPD mean and what does it measure? PPD = (# of patients) x (# of Rxs per patient) x (cost per patient)                 Total # of hospice days PPD is the average price-per-patient per day the hospice ag ... read more


Unnecessary Medications for Dementia Patients

Nov 1st, 2016

The CMS Manual Systems section F329 states “Each resident’s drug regimen must be free from unnecessary drugs.” Despite this regulatory statement, studies have found that as many at 53% of dementia patients took at least 1 unnecessary medication. This percentage increases as the patient trans ... read more


Appropriate Drugs

Oct 1st, 2016

When considering what medications are hospice-covered, we all know to look for drugs that “are used primarily for relief of pain and symptom control related to the individual’s terminal illness.” However, there is more to consider than just covered or not covered. There are appropriate and i ... read more


Hyperdermoclysis

Aug 1st, 2016

Hyperdermoclysis (clysis) is the subcutaneous infusion of fluids for rehydration and dehydration. This method of fluid infusion is beneficial in the hospice setting where many patients are thin with poor venous access and/or poor oral access. Normal saline is administered via gravity fed tubing wit ... read more


Inhaler Use in Hospice Setting

Jul 1st, 2016

When it comes to inhaler use in hospice, there are four factors that determine proper drug deposition with inhaled medications. These are: Inhalation flow Proper use/coordination of the inhaler Aerosol velocity Drug particle size Two of these factors ‐ inhalation flow and proper use/coordinat ... read more


How to Determine Hospice Coverage

Jun 1st, 2016

Hospices are required to cover medications that are reasonable and necessary to relieve patient symptoms and optimize quality of life, not to manage terminal illnesses and related conditions. Hospices are not expected to pay for curative medications or medications that slow disease progression. Sp ... read more


Single Dosing Medications in Syringes

May 1st, 2016

Recently the FDA sent out an alert regarding Becton-Dickenson (B-D) general and oral use syringes. Studies have shown that many drugs dispensed and stored in the syringes lose their potency over time due to a reaction with the syringe stopper. They recommend medications be dispensed and stored in ... read more


Topical Gels and Creams

Apr 1st, 2016

Topical gels and creams have become a go-to for many hospice nurses to treat symptoms of patients who have lost the ability to swallow or who cheek/spit out oral medications. Over and over again Nurses sing the praises of a little cream just rubbed into the forearm. Pharmacists hear from nurses th ... read more


Hospice Schedule II Controlled Substances

Feb 1st, 2016

Federal law allows faxed copies of CII prescriptions to act as original copies. The faxed prescriptions must have the following: Patient name, address and DOB “Hospice Patient” or “Terminally Ill Patient” noted on the prescription Name and strength of the prescribed medicat ... read more


Drug Disposal

Jan 1st, 2016

The Food and Drug Administration (FDA) recommends three drug disposal options: Deliver medications to an approved medication disposal site. A disposal site can be found at http://www.awarerx.pharmacy/dispose-safely. Dispose with household trash: Mix medicines (do not crush tablets or capsules) wi ... read more


Clinician Checklist for Actively Dying Patients

Dec 1st, 2015

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? Gen ... read more


Differences in Pain and Analgesia in Men versus Women

Nov 1st, 2015

Currently, the difference in pain and analgesia between the sexes is not fully understood and no clinical guidelines support different treatment methods. However, here are some suggestions to consider: It’s okay to use similar starting doses between men and women, then titrate for individual ... read more


Rectal Drug Administration

Oct 1st, 2015

A drug’s route of administration is a key consideration when providing palliative care at the end of life. Although the oral route is preferred in most settings, there are many circumstances where this is limited. Administration of medications via the rectum is an essential option that shoul ... read more