Benchmarking opioids in the last 24 hours of life

Ensor, Brian; Middlemiss, Tom

doi:10.1111/j.1445-5994.2009.02132.x

Cited by 6 publications

(4 citation statements)

References 35 publications

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“…The latter difference is probably explained by the fact that Nauck and co-workers also included patients who were discharged from the centre, whereas we solely considered patients who died in the palliative centre. Nevertheless, other studies reported opioid use in 82–97 % [ 28 , 30 , 32 ], and morphine use in 66–93 % [ 27 , 28 , 30 , 32 ] of patients at the end of life, which percentages correspond well with our results.…”

Section: Discussionsupporting

confidence: 92%

“…Eighty-three percent of patients in the present study received a subcutaneous morphine dose of <100 mg/24 h at the day of death, which is considered a low-to-moderate dose [ 27 – 29 ]. In two other studies more than 90 % of the patients received low-to-moderate morphine doses either upon admission [ 27 ] or in the last 24 h before death [ 28 ] .…”

Section: Discussionmentioning

confidence: 99%

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Medication use during end-of-life care in a palliative care centre

et al. 2015

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Background In end-of-life care, symptoms of discomfort are mainly managed by drug therapy, the guidelines for which are mainly based on expert opinions. A few papers have inventoried drug prescriptions in palliative care settings, but none has reported the frequency of use in combination with doses and route of administration. Objective To describe doses and routes of administration of the most frequently used drugs at admission and at day of death. Setting Palliative care centre in the Netherlands. Method In this retrospective cohort study, prescription data of deceased patients were extracted from the electronic medical records. Main outcome measure Doses, frequency and route of administration of prescribed drugs Results All regular medication prescriptions of 208 patients, 89 % of whom had advanced cancer, were reviewed. The three most prescribed drugs were morphine, midazolam and haloperidol, to 21, 11 and 23 % of patients at admission, respectively. At the day of death these percentages had increased to 87, 58 and 50 %, respectively. Doses of these three drugs at the day of death were statistically significantly higher than at admission. The oral route of administration was used in 89 % of patients at admission versus subcutaneous in 94 % at the day of death. Conclusions Nearing the end of life, patients in this palliative care centre receive discomfort-relieving drugs mainly via the subcutaneous route. However, most of these drugs are unlicensed for this specific application and guidelines are based on low level of evidence. Thus, there is every reason for more clinical research on drug use in palliative care.Electronic supplementary materialThe online version of this article (doi:10.1007/s11096-015-0094-3) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Medication use during end-of-life care in a palliative care centre

et al. 2015

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“…2 A New Zealand study of 14 hospices revealed that 75% of patients received a benzodiazepine, predominantly midazolam. 3 In addition, a survey of international palliative care experts found benzodiazepines to be the most common drug prescribed by those polled to treat anxiety, agitation, and terminal restlessness in cancer patients with a life expectancy of days. 1 While it would be reasonable to anticipate similar usage in the United States, the extent and frequency of benzodiazepine use in inpatient hospice settings across the United States has not been studied to date.…”

Section: Introductionmentioning

confidence: 99%

Attitudes Toward Use of Benzodiazepines among U.S. Hospice Clinicians: Survey and Review of the Literature

Kamell

Smith

2016

Journal of Palliative Medicine

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“…Patients in the NZ studies were admitted under the care of specialist palliative care teams. These studies also included the use of the LCP to support patients. The intention of this study was not to compare clinical practices across the two countries but to audit the doses of opioids and sedatives administered to a patient in the last 24 h of life in an acute tertiary hospital in Australia, with and without the utilisation of the mLCP, and to review these doses with those published in the NZ benchmarking studies.…”

Section: Introductionmentioning

confidence: 99%