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Palliative Care Intervention for Choice and Use of Opioids in the Last Hours of Life

¹ Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, Alabama.
² School of Medicine and ³ School of Public Health, University of Alabama at Birmingham.
⁴ Department of Veterans Affairs Medical Center, Birmingham, Alabama.

Address correspondence to Kathryn L. Burgio, PhD, Geriatric Research, Education, and Clinical Center (GRECC), Birmingham VA Medical Center (GRECC/11G), 700 19th Street South, Birmingham, AL 35233. E-mail: kburgio{at}aging.uab.edu

Background. The purpose of this study was to evaluate the effects of a multicomponent palliative care intervention on choice and use of opioid pain medications for symptom control for patients dying in an acute care inpatient setting.

Methods. A preintervention/postintervention trial was conducted between 2001 and 2003. Participants were physician, nursing, and ancillary staff of inpatient services of an urban, tertiary care Veterans Affairs (VA) Medical Center. The intervention included staff education to better identify actively dying patients and a Comfort Care Order Set to guide care in the last hours of life. Data abstracted from computerized medical records of 191 veterans who died during a 6-month period before (N = 98) and after (N = 93) the intervention were used to examine changes in choice and amount of medication administered in the last 3 days of life.

Results. Findings show a significant increase in orders specifically for morphine from 47.4% to 81.7% (p <.001). Orders for hydromorphone or oxycodone did not increase significantly, and no patients had orders for meperidine or codeine. There was an increase in the administration of opioids from 16.7% to 73.0% of patients (p <.001). The amount of opioid administered (in oral morphine equivalents) increased from 31.9 mg/72 hours preintervention to 52.9 mg/72 hours postintervention (p =.12).

Conclusions. The results indicate that the availability of morphine as a preferred opioid and the number of patients who received opioid medication during the last 3 days of life increased after introduction of the inpatient palliative care program.

Key Words: End-of-life care • Palliative care • Comfort care • Inpatient • Physician practice • Veterans

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