How are medications adjusted on Hospice?

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I know each person's situation and medical needs are different but I would be curious to know if you have or had a LO on hospice if and how their meds were adjusted. I know that hospice often stops non essential meds or makes changes. Did they make changes once or were things stopped or reduced over time? Was there a specific incident or change that they decided to reduce or stop them again? How were psychiatric meds handled too? Were they stopped or reduced? If they suspected someone was overly sedated because of meds would they try to address it? I understand that sleeping more is part of this process too so how does that square w meds?

Mom's vitamins were stopped and her zyprexa was cut in half but then increased by 25percent when her behaviors returned and that helped. Her blood pressure meds were stopped a few weeks earlier as she did t need them anymore but I don't think anything else was changed. She has morphine available as a prn and drops to help w secretions as a prn. She hasn't needed the morphine so far and the drops just once I think. She's still eating and taking most meds but has been sleepier since an aspiration incident last week but does seem to be eating better the last few days then earlier in week. She was more awake today tho she was too tired last night to wake for meds.

I've talked to her hospice nurse about some of this and I know we will talk again but in the meantime I'm curious about others' experiences and understanding what this process looks like. We do have a psych nurse from hospice coming in to review the timing of zyprexa and which she gets morning and at dinner. There may be other things to talk about. Mom's psychiatrist no longer practices at the facility and they haven't replaced them yet.

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The meds are tricky and everyone has different opinions, even among medical staff. But the overriding factor is, is the patient as comfortable and pain free as possible. I think many family members expect and hope for interaction with love ones in these final days. Sometimes that's feasable and sometimes it's not. The patient and their comfort is the top priority in hospice.
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I believe the main criterion is comfort. A drug that contributes to comfort (physical and/or emotional) is continued. Pretty much everything else is dropped. Two drugs that were dropped for my husband were added back in when it became apparent that they had been contributing to comfort. (Hallucinations are not comfortable.) The organization we used typically included Haldol in their med kit. I told them I would not be using it because it can have disastrous consequences for people with my husband's disease (and showed the nurse the literature). I was told it was part of the kit but I didn't have to use it. When the kit came, there was no Haldol. I think that hospice really does try to work closely with an individual's needs.

When my mother went on hospice she was only on pain meds. I don't remember if they were continued or replaced. I know that Hospice took over their administration from the nursing home, and had authority to use more than the NH did, without getting further doctor authorization.

I think there is a lot of trial-and-trial-again to customize the care of each patient.
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