Comments on: Administration of Medications to Residents Receiving Hospice Services http://www.careandcompliance.com/blog/resident-care/administration-of-medications-to-residents-receiving-hospice-services_03-11-2008/?utm_source=rss&utm_medium=rss&utm_campaign=administration-of-medications-to-residents-receiving-hospice-services Professional Caregiver - A Care and Compliance Group Blog for Assisted Living and Residential Care Professionals Wed, 08 Feb 2012 08:17:11 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: Fran http://www.careandcompliance.com/blog/resident-care/administration-of-medications-to-residents-receiving-hospice-services_03-11-2008/comment-page-1/#comment-1679 Fran Mon, 27 Dec 2010 11:10:24 +0000 http://www.communityed.com/blog/resident-care/administration-of-medications-to-residents-receiving-hospice-services_03-11-2008/#comment-1679 Thank you for all your comments. It helps some, but I still feel angry about my mom's care which is only nearing end stage. She's had emphysema for years, she suffers from stenosis and arthritis but will NOT take pain pills, recently percocet. Her mind is clear at age 84, my brother has POA and at a recent family meeting the HH care team and my brother rail roaded mom into having him sign for hospice care. All the talk was about morphine. I am a nurse, only recently she was diagnosed with cancer in her sternum. She won't even take percocet or any other pain med because of side effects, yet they lead her to believe Roxinal is going to be a magic remedy and nursing home care will keep her more comfortable. Here is the kicker, she has anemia and the hospitalization from that is when they found the cancer. My anger and arguement is now they will not monitor her Hemaglobin and give her a blood transfusion, her skin is yellow, she is now convinced by them, why not just let the anemia take her out. I am outraged. My brother has POA but I witnessed a combined badgering of facts to talk her into having him sign her on to hospice. I want her anemia monitored and treated, what are my options. Thank you for all your comments. It helps some, but I still feel angry about my mom’s care which is only nearing end stage. She’s had emphysema for years, she suffers from stenosis and arthritis but will NOT take pain pills, recently percocet. Her mind is clear at age 84, my brother has POA and at a recent family meeting the HH care team and my brother rail roaded mom into having him sign for hospice care. All the talk was about morphine. I am a nurse, only recently she was diagnosed with cancer in her sternum. She won’t even take percocet or any other pain med because of side effects, yet they lead her to believe Roxinal is going to be a magic remedy and nursing home care will keep her more comfortable. Here is the kicker, she has anemia and the hospitalization from that is when they found the cancer. My anger and arguement is now they will not monitor her Hemaglobin and give her a blood transfusion, her skin is yellow, she is now convinced by them, why not just let the anemia take her out. I am outraged. My brother has POA but I witnessed a combined badgering of facts to talk her into having him sign her on to hospice. I want her anemia monitored and treated, what are my options.

]]> By: Linda M. Jekel, RN http://www.careandcompliance.com/blog/resident-care/administration-of-medications-to-residents-receiving-hospice-services_03-11-2008/comment-page-1/#comment-1122 Linda M. Jekel, RN Thu, 02 Dec 2010 04:43:07 +0000 http://www.communityed.com/blog/resident-care/administration-of-medications-to-residents-receiving-hospice-services_03-11-2008/#comment-1122 After reading the many comments on hospice pain medication administration, etc, I humbly offer a SUMMARY of some FACTS, as I Know them:>>>>>> 1. Liquid Morphine 20 mg/ ml (Brand Name= Roxinal) helps both pain and respiratory distress. It is truly useful for FAST relief, for easy under-the tongue administration--and in conjunction with longer acting pain meds (such as MS Contin--meaning long-acting Morphine; normally given in varioius doses, every 12 hours around the clock). Typically MS CONTIN would form the framework for continued pain control. Also note, the FAST-ACTING Roxinal is used for "breakthrough pain" or resp. distress, and given as needed (PRN). The long-acting MS CONTIN (or other) such meds.work WITH Roxinal. A person could, of course, be taking only one or the other, but clearly they each have a role. In fact, slowly introducing Roxinal helps the RN or MD determine what MS dose levels are needed for full, long-acting relief. 2. No one has to die in pain; there are so many avenues of relief. Sadly, not all practitioners have adequate training in PALLIATIVE (comfort) Care. For example, one writer mentioned CODEINE. This is fine for short-term use, but it is very constipating and rarely used long-term and/or in Palliative care. Dilaudid is another med I have seen used in an ICU for a Cancer Patient--even though she clearly came into the ICU with good pain control obtained by Long- and Fast-Acting Morphine ( Ex. MS Contin & Roxinal). Unfortunately, this lady was switched to the Dilaudid injection and the pain came bck with a vengence. Why? I would suppose that short-sighted hospital RX habit is why. 4. As for the man with the fractured back--and other injuries involving NERVE PAIN--Morphine alone (or at all) may not be ideal for you. For this, GabaPentin (Neurontin)--an anti-seizure med--can help due to its nerve system influence. There are several types of pain--gut pain, bone pain, nerve, etc. Nerve pain is sharp and stabbing--and uniquely easy to identify. (Think migraine headache or terrible touch ache). Of late, METHADONE has been used with great success since it addresses nerve and other pain. These meds are started slowly, advanced safely. 5. You may have to suggest these pain med options. I have done so, and the MDs often said: "OK; I never thought of that." One of the uses for FAST-ACTING Roxinal is along with MS CONTIN (or other) Neither Roxinal or MS Contin cause death or stop respirations--despite the corny TV shows where someone says: "OH NO...they put them on the morphine." Quoting Dr. Brad Stuart of the Sutter Hospice group--"Morphine is THE drug of CHOICE for cancer pain relief," and for many other end-stage needs. Nonetheless, even when caring for an elderly MD with Lung Cancer, I had to convince him that the Morphine (espec. the ROXINAL) would not suppress his respirations. He quickly saw the light. 6. Duragesic (Fentynl) patches are often used when other relief is not adequate. For example, I had a 50 yr old Pancreatic Cancer patient who needed quite high patch doses to suppress his pain. Yes, they are expensive. I think we run into problems when hospitals slap one of these on the patient as they are disharged. Often too soon, in my view. Then the hospice staff look stingy when they steer the patient appropriately to a more reasonable med for their situation. The PATCH is not a 1st line of pain-control action; for the lack of a better term, it is "overkill." Safer, cheaper meds are available for regular use. The patch, when needed, is more for advanced, intractable pain. And YES, Medicare expects hospice to use meds wisely, in the interest of overall economy. Why pick a $50- $100 patch, when cost-effective, easier to use Morpine variations work better in many patients. I think Roxinal cost less than $10.00 for a 30 cc bottle. Sorry to be long-winded, but there are SO MANY MYTHS about hospice, morphine, and other aspects of comfort care. After reading the many comments on hospice pain medication administration, etc, I humbly offer a SUMMARY of some FACTS, as I Know them:>>>>>>
1. Liquid Morphine 20 mg/ ml (Brand Name= Roxinal) helps both pain and respiratory distress. It is truly useful for FAST relief, for easy under-the tongue administration–and in conjunction with longer acting pain meds (such as MS Contin–meaning long-acting Morphine; normally given in varioius doses, every 12 hours around the clock). Typically MS CONTIN would form the framework for continued pain control. Also note, the FAST-ACTING Roxinal is used for “breakthrough pain” or resp. distress, and given as needed (PRN). The long-acting MS CONTIN (or other) such meds.work WITH Roxinal. A person could, of course, be taking only one or the other, but clearly they each have a role. In fact, slowly introducing Roxinal helps the RN or MD determine what MS dose levels are needed for full, long-acting relief.
2. No one has to die in pain; there are so many avenues of relief. Sadly, not all practitioners have adequate training in PALLIATIVE (comfort) Care.
For example, one writer mentioned CODEINE. This is fine for short-term use, but it is very constipating and rarely used long-term and/or in Palliative care. Dilaudid is another med I have seen used in an ICU for a Cancer Patient–even though she clearly came into the ICU with good pain control obtained by Long- and Fast-Acting Morphine ( Ex. MS Contin & Roxinal). Unfortunately, this lady was switched to the Dilaudid injection and the pain came bck with a vengence. Why? I would suppose that short-sighted hospital RX habit is why.
4. As for the man with the fractured back–and other injuries involving NERVE PAIN–Morphine alone (or at all) may not be ideal for you. For this,
GabaPentin (Neurontin)–an anti-seizure med–can help due to its nerve system influence. There are several types of pain–gut pain, bone pain, nerve, etc. Nerve pain is sharp and stabbing–and uniquely easy to identify. (Think migraine headache or terrible touch ache). Of late, METHADONE has been used with great success since it addresses nerve and other pain. These meds are started slowly, advanced safely.
5. You may have to suggest these pain med options. I have done so, and the MDs often said: “OK; I never thought of that.” One of the uses for FAST-ACTING Roxinal is along with MS CONTIN (or other) Neither Roxinal or MS Contin cause death or stop respirations–despite the corny TV shows where someone says: “OH NO…they put them on the morphine.” Quoting Dr. Brad Stuart of the Sutter Hospice group–”Morphine is THE drug of CHOICE for cancer pain relief,” and for many other end-stage needs. Nonetheless, even when caring for an elderly MD with Lung Cancer, I had to convince him that the Morphine (espec. the ROXINAL) would not suppress his respirations. He quickly saw the light.
6. Duragesic (Fentynl) patches are often used when other relief is not adequate. For example, I had a 50 yr old Pancreatic Cancer patient who needed quite high patch doses to suppress his pain. Yes, they are expensive. I think we run into problems when hospitals slap one of these on the patient as they are disharged. Often too soon, in my view. Then the hospice staff look stingy when they steer the patient appropriately to a more reasonable med for their situation. The PATCH is not a 1st line of pain-control action; for the lack of a better term, it is “overkill.” Safer, cheaper meds are available for regular use. The patch, when needed, is more for advanced, intractable pain. And YES, Medicare expects hospice to use meds wisely, in the interest of overall economy. Why pick a $50- $100 patch, when cost-effective, easier to use Morpine variations work better in many patients. I think Roxinal cost less than $10.00 for a 30 cc bottle.

Sorry to be long-winded, but there are SO MANY MYTHS about hospice, morphine, and other aspects of comfort care.

]]> By: Linda M. Jekel, RN, MS, LNC http://www.careandcompliance.com/blog/resident-care/administration-of-medications-to-residents-receiving-hospice-services_03-11-2008/comment-page-1/#comment-1101 Linda M. Jekel, RN, MS, LNC Wed, 17 Nov 2010 08:22:57 +0000 http://www.communityed.com/blog/resident-care/administration-of-medications-to-residents-receiving-hospice-services_03-11-2008/#comment-1101 Sorry my response took a while. Also, I am sorry for your loss of your mom. Kidney failure affects so much of the other organs,it is often the cause of death in older people. As for theuse of Roxinal (sublingunal Morphine Sulfate Liquid), the nurse at the SNF was only partly correct---Roxinal is used for air hunger or any possible respiratory distress at the end of life, particularly in the last 48-72 hrs. The SNF nurse seemed to contradict her/himself. Roxinal IS NOT--I stress--going to suppress respirations. It is easily administered (no swallowing needed), is fast-acting, and has the ability to address PAIN and RESPIRATORY discomfort (plus some related restlessness or anxiety). It is THE DRUG OF CHOICE for handing end-stage pain in cancer patients, for instance. WIth alert patients, I have had many who told me how quickly and how well Roxinal helped their pain or shortness of breath. HOW DOES IT WORK? The lungs have morphine receptors and Roxinal not only works on these, but it helps relax the diaphragm. It is an ideal medicatgion for easing the discomforts of those close to death (and as a fast-acting aide for breakthrough pain). It is the only such medication I know of that has DUAL-BENEFITS, as it quicklyt helps pain and/or shortness of breath. Withholding it in the dying patient is not indicated. Hospice (where I have worked for 8 years) uses it quite liberally. I have had patients receiving 2.5 to 20 mg (or more) every 2 -3 hrs around the clock, as needed. There is no sense withholding it for the actively-dying patient. Unfortunately, there still exist some incorrect thinking and myths about its use. More education is needed from hospice professionals to be sure it is used correctly---aka, used adequately. Thanks for your question; hope this eases your mind. Most Sincerely, Linda M. Jekel, RN, MS, LNC Mountain View, CA Sorry my response took a while. Also, I am sorry for your loss of your mom.

Kidney failure affects so much of the other organs,it is often the cause of death in older people. As for theuse of Roxinal (sublingunal Morphine Sulfate Liquid), the nurse at the SNF was only partly correct—Roxinal is used for air hunger or any possible respiratory distress at the end of life, particularly in the last 48-72 hrs. The SNF nurse seemed to contradict her/himself.

Roxinal IS NOT–I stress–going to suppress respirations. It is easily administered (no swallowing needed), is fast-acting, and has the ability to address PAIN and RESPIRATORY discomfort (plus some related restlessness or anxiety). It is THE DRUG OF CHOICE for handing end-stage pain in cancer patients, for instance. WIth alert patients, I have had many who told me how quickly and how well Roxinal helped their pain or shortness of breath.

HOW DOES IT WORK?
The lungs have morphine receptors and Roxinal not only works on these, but it helps relax the diaphragm. It is an ideal medicatgion for easing the discomforts of those close to death (and as a fast-acting aide for breakthrough pain). It is the only such medication I know of that has DUAL-BENEFITS, as it quicklyt helps pain and/or shortness of breath.

Withholding it in the dying patient is not indicated. Hospice (where I have worked for 8 years) uses it quite liberally. I have had patients receiving 2.5 to 20 mg (or more) every 2 -3 hrs around the clock, as needed.
There is no sense withholding it for the actively-dying patient. Unfortunately, there still exist some incorrect thinking and myths about its use.

More education is needed from hospice professionals to be sure it is used correctly—aka, used adequately.

Thanks for your question; hope this eases your mind.

Most Sincerely,
Linda M. Jekel, RN, MS, LNC
Mountain View, CA

]]> By: Kathleen Shamblen http://www.careandcompliance.com/blog/resident-care/administration-of-medications-to-residents-receiving-hospice-services_03-11-2008/comment-page-1/#comment-1084 Kathleen Shamblen Thu, 04 Nov 2010 00:41:24 +0000 http://www.communityed.com/blog/resident-care/administration-of-medications-to-residents-receiving-hospice-services_03-11-2008/#comment-1084 My father Paul Raidt had four years with us after Pancreatic cancer. Unfortunately some of the treatments played havoc with his bone marrow. We tried transfusions with success until the last month when his body began to react against them. When hospice was called he had a white count of only 8000. We were informed he could easily bleed out. We were also aware his blood pressure dropped to as low as 52/45 when he stood. He tried as long as he could - when he did stand he went into sheer panic trying to just get some air. Hospice was amazing! At times I have wondered if the dosages given of Adavan or Roxinal would shorten his life with us. What they did was give him the ability to relax and breathe. It kept him from the panic and fright. He stayed and held my mother's hand until his last. What allowed him to transition was the peace and love from his family with the support of Hospice. What allowed him to leave was my Mother saying she would be all right, she had all of us to look out for her....he died within minutes. My mother was also on hospice care at the time - that day was August 19, 2009 - she has PSP. - again we are using Roxinal - we're lucky to have it and Hospice! My father Paul Raidt had four years with us after Pancreatic cancer. Unfortunately some of the treatments played havoc with his bone marrow. We tried transfusions with success until the last month when his body began to react against them. When hospice was called he had a white count of only 8000. We were informed he could easily bleed out. We were also aware his blood pressure dropped to as low as 52/45 when he stood. He tried as long as he could – when he did stand he went into sheer panic trying to just get some air. Hospice was amazing! At times I have wondered if the dosages given of Adavan or Roxinal would shorten his life with us. What they did was give him the ability to relax and breathe. It kept him from the panic and fright. He stayed and held my mother’s hand until his last. What allowed him to transition was the peace and love from his family with the support of Hospice. What allowed him to leave was my Mother saying she would be all right, she had all of us to look out for her….he died within minutes. My mother was also on hospice care at the time – that day was August 19, 2009 – she has PSP. – again we are using Roxinal – we’re lucky to have it and Hospice!

]]> By: L. Sherman http://www.careandcompliance.com/blog/resident-care/administration-of-medications-to-residents-receiving-hospice-services_03-11-2008/comment-page-1/#comment-1063 L. Sherman Fri, 15 Oct 2010 06:30:55 +0000 http://www.communityed.com/blog/resident-care/administration-of-medications-to-residents-receiving-hospice-services_03-11-2008/#comment-1063 My husband passed away 3 weeks ago after suffering for years with COPD. Along with that he had an inoperable blocked artery in his heart along with stage 3-4 kidney disease. He also had CHF. Because he was getting progressively worse and one day just could not walk 2 steps without having breathing difficulties and had to use his nebulizer whenever he moved a few steps. After speaking with his physician, we came to the conclusion that Hospice would be best because of the palliative care. Thank the Lord for Hospice and their caring and compassionate nurses. I told my husband, so as not to frighten him, that patients have come off of Hospice with improvement, even though down deep I knew he would never get off. His breathing became more and more difficult each day and it causes a strain on his already sick heart but we continued giving him his meds for whatever he took before. Yes, he was on Roxinal and we told him it was a medication to help him breathe so he took it reluctantly because giving him a tyelenol was a struggle. I felt as you that maybe we hastened his death by giving him this medication. I was with him when he passed away, my family was here with him and had been for weeks and that was the best comfort that we could have asked for. The last night of his night he was agitated and having a very hard time breathing. They gave him Adivan and every 2 hrs Roxinal. Hospice did not cause him to pass, Hospice helped him to pass pain free and even though I miss him terribly and the lonliness is almost unbearable, I know that everything to keep him comfortable was given to him and he died peacefully. I did not want to let go and held him in my arms for a couple of hours until he was transported to the funeral home. All the Hospice nurses should be blessed as they are the most sincere, compassionate and caring people that I have ever met and cannot rave about them enough for helping me, my family and most of all, my dear husband. He is now resting in peace and is no longer suffering and that is the peace I can live with. My husband passed away 3 weeks ago after suffering for years with COPD. Along with that he had an inoperable blocked artery in his heart along with stage 3-4 kidney disease. He also had CHF. Because he was getting progressively worse and one day just could not walk 2 steps without having breathing difficulties and had to use his nebulizer whenever he moved a few steps. After speaking with his physician, we came to the conclusion that Hospice would be best because of the palliative care. Thank the Lord for Hospice and their caring and compassionate nurses. I told my husband, so as not to frighten him, that patients have come off of Hospice with improvement, even though down deep I knew he would never get off. His breathing became more and more difficult each day and it causes a strain on his already sick heart but we continued giving him his meds for whatever he took before. Yes, he was on Roxinal and we told him it was a medication to help him breathe so he took it reluctantly because giving him a tyelenol was a struggle. I felt as you that maybe we hastened his death by giving him this medication. I was with him when he passed away, my family was here with him and had been for weeks and that was the best comfort that we could have asked for. The last night of his night he was agitated and having a very hard time breathing. They gave him Adivan and every 2 hrs Roxinal. Hospice did not cause him to pass, Hospice helped him to pass pain free and even though I miss him terribly and the lonliness is almost unbearable, I know that everything to keep him comfortable was given to him and he died peacefully. I did not want to let go and held him in my arms for a couple of hours until he was transported to the funeral home. All the Hospice nurses should be blessed as they are the most sincere, compassionate and caring people that I have ever met and cannot rave about them enough for helping me, my family and most of all, my dear husband. He is now resting in peace and is no longer suffering and that is the peace I can live with.

]]> By: kelley weldin http://www.careandcompliance.com/blog/resident-care/administration-of-medications-to-residents-receiving-hospice-services_03-11-2008/comment-page-1/#comment-1055 kelley weldin Sun, 03 Oct 2010 14:32:20 +0000 http://www.communityed.com/blog/resident-care/administration-of-medications-to-residents-receiving-hospice-services_03-11-2008/#comment-1055 Dear Sir/Madam- I guess you have to dieing to get Roxinal, buy it would be nice to have a fast acting, strong pain killer. I was in an car accident where I broke my back, in three places and split my head opem, causing it to be stapled back together. This left me paralyzed from the chest down. My back hurts all the time, and at times it hurts to breathe. I appreciate the dying patient, but what about the possibly living. The Dr. had to prove I was in pain ($6000.) MRI to give me codiene? What is worng, with this system we have? Now, he is acting like he has to justify this!!! It's called permanent pain requiring narcotics permanently, Get used to it! Damn paper pushers. Dear Sir/Madam-
I guess you have to dieing to get Roxinal, buy it would be nice to have a fast acting, strong pain killer.
I was in an car accident where I broke my back, in three places and split my head opem, causing it to be stapled back together. This left me paralyzed from the chest down. My back hurts all the time, and at times it hurts to breathe. I appreciate the dying patient, but what about the possibly living.
The Dr. had to prove I was in pain ($6000.) MRI to give me codiene?
What is worng, with this system we have? Now, he is acting like he has to justify this!!! It’s called permanent pain requiring narcotics permanently, Get used to it! Damn paper pushers.

]]> By: Angela http://www.careandcompliance.com/blog/resident-care/administration-of-medications-to-residents-receiving-hospice-services_03-11-2008/comment-page-1/#comment-1034 Angela Sun, 19 Sep 2010 14:30:47 +0000 http://www.communityed.com/blog/resident-care/administration-of-medications-to-residents-receiving-hospice-services_03-11-2008/#comment-1034 I have a question about the use of Roxinal. My mother recently was hospitalized with kidney failure. She had been fighting renal cell carcinoma for 6 years and the one kidney she had was not functioning optimally. We had her transfered to a SNF with comfort measures only. The last week or so she was unresponsive to us only opening her eyes briefly when we would speak to her. She was prescribed a duragesic patch for pain control when she no longer was able to swallow her meds and roxinal was also ordered PRN. I questioned one of the nurses about giving her the dose when I thought that she was having break through pain. She informed me that this medication was really for when she became air hungry and was strugling to breath and should be saved for such occasion for it would suppress her respiratory system. Less than one week ago my mother passed very suddenly. She had been comfortable with no signs of respiratory distress, no labored breathing, BP 94/72. When speaking to the nurse on this shift she told me that she had given her a dose of roxinal because she was uncomfortable when being turned for bathing. I firmly believe this nurse assisted my mothers death before she was ready to leave us. Under these circumstances, does roxinal suppress the respiratory system to the point of death? I can't help feeling that I was robbed of even a day or two more with her. I have a question about the use of Roxinal. My mother recently was hospitalized with kidney failure. She had been fighting renal cell carcinoma for 6 years and the one kidney she had was not functioning optimally. We had her transfered to a SNF with comfort measures only. The last week or so she was unresponsive to us only opening her eyes briefly when we would speak to her.

She was prescribed a duragesic patch for pain control when she no longer was able to swallow her meds and roxinal was also ordered PRN. I questioned one of the nurses about giving her the dose when I thought that she was having break through pain. She informed me that this medication was really for when she became air hungry and was strugling to breath and should be saved for such occasion for it would suppress her respiratory system.

Less than one week ago my mother passed very suddenly. She had been comfortable with no signs of respiratory distress, no labored breathing, BP 94/72. When speaking to the nurse on this shift she told me that she had given her a dose of roxinal because she was uncomfortable when being turned for bathing. I firmly believe this nurse assisted my mothers death before she was ready to leave us.

Under these circumstances, does roxinal suppress the respiratory system to the point of death? I can’t help feeling that I was robbed of even a day or two more with her.

]]> By: Pam Y. http://www.careandcompliance.com/blog/resident-care/administration-of-medications-to-residents-receiving-hospice-services_03-11-2008/comment-page-1/#comment-890 Pam Y. Wed, 07 Apr 2010 16:40:08 +0000 http://www.communityed.com/blog/resident-care/administration-of-medications-to-residents-receiving-hospice-services_03-11-2008/#comment-890 Chris, I'm really sorry for pain you feel at the thought of losing your mom. You're not selfish at all. It seems as though you need for the hospice staff to give you some education about the medications they're giving your mom. The National Hospice and Palliative Care Organization has done a study that shows that people who get on hospice services early enough often live up to 28 days longer with better quality of life. Morphine is a great respiratory medication for easing shortness of breath for people who are in their end of life. It should not make her incoherant. It may make her sleepier for a few days, but her body will adjust and she won't be as sleepy (at least from the medication). As her disease progresses she will sleep more and more. This is normal (with or without the medication). It 's okay when you're with her to wake her and visit with her. She'll go back to sleep, easily. She may doze in the middle of a conversation, but you can pick up the conversation later. Please ask the hospice to take some time with you to get all your questions answered. My prayers are with you. Chris, I’m really sorry for pain you feel at the thought of losing your mom. You’re not selfish at all. It seems as though you need for the hospice staff to give you some education about the medications they’re giving your mom. The National Hospice and Palliative Care Organization has done a study that shows that people who get on hospice services early enough often live up to 28 days longer with better quality of life. Morphine is a great respiratory medication for easing shortness of breath for people who are in their end of life. It should not make her incoherant. It may make her sleepier for a few days, but her body will adjust and she won’t be as sleepy (at least from the medication). As her disease progresses she will sleep more and more. This is normal (with or without the medication). It ‘s okay when you’re with her to wake her and visit with her. She’ll go back to sleep, easily. She may doze in the middle of a conversation, but you can pick up the conversation later. Please ask the hospice to take some time with you to get all your questions answered. My prayers are with you.

]]> By: chris.p http://www.careandcompliance.com/blog/resident-care/administration-of-medications-to-residents-receiving-hospice-services_03-11-2008/comment-page-1/#comment-889 chris.p Sat, 03 Apr 2010 13:50:14 +0000 http://www.communityed.com/blog/resident-care/administration-of-medications-to-residents-receiving-hospice-services_03-11-2008/#comment-889 Today April 3rd my mom was put on hospice and im not happy with it because of the drugs they are going to give her that will most likely stop her heart because she has copd and emphysema, diabetes ,and several back operations and she is fighting for each breath. I realize that I am unhappy because she is so coherent and it sucks to see my mom look so good but feel so bad that she wants to die and the more I think about it the more I cry. So I need to be more understanding about how she feels and not be so selfish but it's too hard for me to deal with. I really need to prepare myself for my moms death so if there are any words that someone could say to me to help ease my mind I welcome it cause I know im not the only one hurting. Thanks for reading and I hope it might help someone else who is also hurting. Today April 3rd my mom was put on hospice and im not happy with it because of the drugs they are going to give her that will most likely stop her heart because she has copd and emphysema, diabetes ,and several back operations and she is fighting for each breath. I realize that I am unhappy because she is so coherent and it sucks to see my mom look so good but feel so bad that she wants to die and the more I think about it the more I cry. So I need to be more understanding about how she feels and not be so selfish but it’s too hard for me to deal with. I really need to prepare myself for my moms death so if there are any words that someone could say to me to help ease my mind I welcome it cause I know im not the only one hurting.
Thanks for reading and I hope it might help someone else who is also hurting.

]]> By: Rita Morris http://www.careandcompliance.com/blog/resident-care/administration-of-medications-to-residents-receiving-hospice-services_03-11-2008/comment-page-1/#comment-884 Rita Morris Mon, 08 Mar 2010 21:42:05 +0000 http://www.communityed.com/blog/resident-care/administration-of-medications-to-residents-receiving-hospice-services_03-11-2008/#comment-884 I understand what you are saying completely. I went through these same feelings when my mother was terminally ill in 2009. My mother's wish was the same. She had lymphoma and wanted to be coherent and live life as best she could but she did not want to be in pain. It seemed the hospice nurse didn't understand the "live life as best she could" part. She only heard my mom didn't want to be in pain. She discussed the drugs and discussed the drugs - morphine and others - until mom acquiesced. Once on the morphine there was no going back. As I look back more than a year since her death I have begun to understand that a terminally ill patient cannot live pain free without the drugs and the drugs are so powerful if they are to control pain the patient cannot be coherant. I am so sorry about the suffering you, the loved one and caregiver, are experiencing. Hospice provides us the opportunity to care for our loved ones in a less sterile environment than a hospital or nursing home, but the days of care can be difficult, wonderful, disappointing, angering, and a blessing at the same time. I understand what you are saying completely. I went through these same feelings when my mother was terminally ill in 2009. My mother’s wish was the same. She had lymphoma and wanted to be coherent and live life as best she could but she did not want to be in pain. It seemed the hospice nurse didn’t understand the “live life as best she could” part. She only heard my mom didn’t want to be in pain. She discussed the drugs and discussed the drugs – morphine and others – until mom acquiesced. Once on the morphine there was no going back. As I look back more than a year since her death I have begun to understand that a terminally ill patient cannot live pain free without the drugs and the drugs are so powerful if they are to control pain the patient cannot be coherant. I am so sorry about the suffering you, the loved one and caregiver, are experiencing. Hospice provides us the opportunity to care for our loved ones in a less sterile environment than a hospital or nursing home, but the days of care can be difficult, wonderful, disappointing, angering, and a blessing at the same time.

]]>