Using Evidence Based Medicine to Ethically Provide End of Life Symptom Control
|
|
|
- Gwendolyn Richardson
- 5 years ago
- Views:
Transcription
1 Using Evidence Based Medicine to Ethically Provide End of Life Symptom Control Erin Zimny, MD Emergency Medicine Hospice and Palliative Medicine Henry Ford Hospital
2 Disclosures I do NOT have any financial disclosures I WILL be discussing off label prescribing
3 Objectives Discuss strategies for treating intractable pain Why the Doctrine of Double Effect matters here Review mechanisms and treatments for nausea How to fix constipation fast Comprehensive approach to dyspnea treatment
4 Opioid Pain Management Pearls Scrub s Pain Clip
5 Wait, Which Medicine? Generic Name IV Short PO Long PO Codiene Hydrocodone Oxycodone T3 Norco Vicodin Lortab Oxycodone Percocet Roxicodone Morphine Morphine MSIR Roxanol Hydromorphone Dilaudid Dilaudid IR Palladone Fentanyl Fentanyl Actiq Sublimaze (nasal/buccal) Zohydro ER Oxycontin MS Contin Oramorph SR Kadian Palladone SR Jurnista Duragesic (patch)
6 Pain Pearls IV to PO dosing 1:3 Time to Onset and Duration for morphine IV 6-10 minutes and lasts 2 hours IM 30 minutes and lasts 2 hours PO 60 minutes and lasts 4 hours Common Conversions PO hydrocodone = PO morphine PO oxycodone is 1.5 x stronger than PO morphine IV hydromorphine is 5-7 x stronger than IV morphine
7 Choosing the Med and the Dose Morphine IV weight based dosing 0.1mg/kg Fentanyl IV weight based dosing starts at 1-2 mcg/kg Hydromorphone IV dosing starts at mg/kg Morphine more renal metabolism Hydromorphone and fentanyl more liver
8 Doctrine of Double Effect The permissibility of an action that causes a serious harm, even death, as a side effect of promoting some good end Treating pain versus euthanasia/physician assisted suicide
9 Understanding and Treating Nausea
10 Defining Nausea & Vomiting Nausea Subjective sensation Stimulation Vomiting Neuromuscular reflex
11 Causes of Nausea & Vomiting Metastases Meningeal irritation Movement Mental anxiety Medications Mucosal irritation Mechanical Obstruction Motility Metabolic Microbes Myocardial
12
13 Dopamine Antagonists Haloperidol, Prochlorperazine, Droperidol, Thiethylperazine, Promethazine, Perphenazine, Trimethobenzamide Acetylcholine Antagonists (anticholinergics) Scopolamine Histamine Antagonists (antihistamines) Diphenhydramine, Meclizine, Hydroxyzine Serotonin Antagonists Ondansetron, Granisetron
14 Prokinetic Agents Metoclopramide Antacids H 2 receptor antagonists Cimetidine, Famotidine, Ranitidine Proton pump inhibitors Omeprazole, Lansoprazole Cytoprotective Agents Misoprostol Others Dexamethasone, Tetrahydrocannabinol
15
16 Constipation
17 Causes of Constipation Medications Decreased mobility Ileus Mechanical obstruction Malignancy Metabolic abnormalities Spinal cord compression Dehydration Autonomic dysfunction
18 Management Options Stimulant laxatives Prune juice, Casanthranol Senna Bisacodyl Osmotic laxatives Lactulose or sorbitol Milk of magnesia Magnesium citrate Detergent laxatives AKA stool softeners Sodium docusate Calcium docusate Prokinetic agents Metoclopramide Lubricant stimulants Glycerin suppositories Oils (mineral or peanut) Large-volume enemas Warm water Soap suds
19 Opioid Constipation Occurs with ALL opioids Never develop tolerance to this side effect Dietary interventions alone not sufficient Avoid bulk-forming agents Fiber doesn t fix this!
20 Bowel Regimen with Opioids All patients on opioids should have combo plan Softner plus stimulant Senna + docusate sodium scheduled (Senna S) Lactulose prn
21 Methylnaltrexone Relistor 8-12mg subcutaneous Peripherally acting opioid antagonist Does not cross blood brain barrier
22 Dyspnea
23 Defining Dyspnea Described as shortness of breath, smothering, inability to get air, or suffocation Only patient self report is reliable Looks like fear Does not correlate to RR, po2, or blood gas 21-78% of cancer pts, 56% in COPD, 68% in HIV, 61-70% in CHF, 70% in dementia
24 Causes of Dyspnea Anxiety Airway obstruction Bronchospasm Hypoxemia Pleural effusion Pneumonia Pulmonary edema Pulmonary embolism Thick secretions Anemia Metabolic Stress
25 Management of Dyspnea Treat underlying cause Symptomatic management Oxygen Opioids Anxiolytics Nonpharmalogical
26 Oxygen To treat symptom, not pulse ox Symbol of medical care Don t obstruct ability to communicate if able to communicate at end of life Fan may be just as effective
27 Opioids Central and peripheral action Decrease chemoreceptor response to hypercapnia Increase peripheral vasodilation Decrease anxiety and subjective dyspnea Small doses Morphine IV 2-5 mg q10-30 minutes prn Ethical intent is to relieve dyspnea
28 Anxiolytics Small doses Safe in combination with opioids (in small doses) Lorazepam mg IV q30 minutes prn
29 Nonpharmacologic Introduce humidity Reposition/elevate head Educate/support family Consider treating secretions Atropine or scopolamine or glycopyrolate
30 Palliative Care Resources Palliative Fast Facts EPEC education
31 Topics Covered on Fast Facts Prognostication Dementia Liver Failure COPD CHF AIDS After CPR Symptom control Nausea Diarrhea / Constipation Dyspnea Pain management Chronic pain Malignant pain Equianalgesic dosing Syndrome of imminent death Opioids at the end of life Terminal extubation Medical futility
32
33 Questions and Comments To cure, occasionally To relieve, often To comfort, always Hippocrates
Attach patient label here. Physician Orders ADULT: Palliative Care Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase T;N, Phase: Palliative Care Phase, When to Initiate: Palliative Care Phase Admission/Transfer/Discharge Patient Status Initial
Agitation Excessive physical or mental restlessness. Increased activity that is generally not purposeful and associated with anxiety.
October 2012 4 Agitation Excessive physical or mental restlessness. Increased activity that is generally not purposeful and associated with anxiety. Depending on appropriateness, evaluate for reversible
Second term/
Second term/ 2015-2016 L. 1 Dr Mohammed AL-Zobaidy Learning objectives GIT pharmacology After completing this chapter the student will be able to: Recognise pathophysiological factors implicated in acid-peptic
Management of Dyspnea and Cough in Lung Cancer
Management of Dyspnea and Cough in Lung Cancer Dr. Chris Ogaranko Lung Cancer Educational Event November 2013 Presenter Disclosure Faculty: Dr. Chris Ogaranko Relationships with commercial interests: Grants/Research
Pharmacology. Drugs that Affect the Gastrointestinal System
Pharmacology Drugs that Affect the Gastrointestinal System Topics Peptic Ulcer Disease Constipation Diarrhea Emesis Digestion Peptic Ulcer Disease Factors that Increase Acidity Factors that Protect Against
SYMPTOM MANAGEMENT GUIDANCE FOR PATIENTS RECEIVING PALLIATIVE CARE AT ROYAL DERBY HOSPITAL
SYMPTOM MANAGEMENT GUIDANCE FOR PATIENTS RECEIVING PALLIATIVE CARE AT ROYAL DERBY HOSPITAL If a patient is believed to be approaching the end of their life, medication should be prescribed in anticipation
Dyspnea. Stephanie Lindsay
Dyspnea Stephanie Lindsay What is dyspnea? An unpleasant sensation of difficult, labored breathing Shortness of air Dyspnea is not the same as tachypnea therefore patients may not present with rapid breathing
Constipation and bowel obstruction
Constipation and bowel obstruction Constipation Infrequent or difficult defecation with reduced number of bowel movements, which may or may not be abnormally hard with increased difficulty or discomfort
Nausea and Vomiting in Palliative Care
Nausea and Vomiting in Palliative Care Definitions Nausea - an unpleasant feeling of the need to vomit Vomiting - the expulsion of gastric contents through the mouth, caused by forceful and sustained contraction
Pain Management Strategies Webinar/Teleconference
Pain Management Strategies Webinar/Teleconference Barry K. Baines, MD April 16, 2009 Objectives Describe the principles of pain management. Identify considerations in the use of opioids. Describe the benefits
Constipation An Overview. Definition Physiology of GI tract Etiology Assessment Treatment
CONSTIPATION Constipation An Overview Definition Physiology of GI tract Etiology Assessment Treatment Definition Constipation = the infrequent passage of hard feces Definition of Infrequent The meaning
Constipation an Old Friend. Presented by Dr. Keith Harris
Constipation an Old Friend Presented by Dr. Keith Harris Irregularity and the Tricks of the Trade." CONSTIPATION What is constipation? INFREQUENT BOWEL MOVEMENTS DIFFICULTY DURING DEFECATION SENSATION
Lab:2 Drugs acting on Gastrointestinal tract
Lab:2 Drugs acting on Gastrointestinal tract Drugs that used to treat three common medical conditions involving the gastrointestinal tract: peptic ulcers and gastroesophageal reflux disease (GERD), chemotherapy-induced
(30689) PROT Pain PCA Adult Patient Controlled Analgesia
Diagnosis Allergies Nursing Assess and Document PCA: 1. Assess and document pain rating, sedation level and respiratory rate every 2 hours; assess and document pain rating, sedation level and respiratory
Palliative Care for Primary Care Providers QUYNH BUI, MD MPH DECEMBER 2015
Palliative Care for Primary Care Providers QUYNH BUI, MD MPH DECEMBER 2015 Objectives Define palliative care and primary palliative care Describe the rationale for providing primary palliative care in
Managing Care at End of Life:
Managing Care at End of Life: Physical Suffering Pain & Dyspnea Verna Sellers, MD, MPH, AGSF Medical Director Centra PACE Lynchburg, Virginia 1 Speaker Disclosures: Dr. Sellers has disclosed that she has
PAIN. TREATMENT TABLES Analgesics. NON-OPIOID ANALGESICS Generic Name Trade Names (Examples) Duration Initial Dose
NON-OPIOID SHORT-ACTING LONG-ACTING **** O PAIN TREATMENT TABLES Analgesics NON-OPIOID ANALGESICS Generic Name Trade Names (Examples) Duration Initial Dose Tramadol 50 mg Ultram Every 4 hours 1-2 tabs,
Nausea. Assessment & Management. R J Crossno, MD, CMD, FAAFP, FAAHPM. Disclosures
Nausea Assessment & Management R J Crossno, MD, CMD, FAAFP, FAAHPM Disclosures Dr. Crossno discloses his employment as Area Medical Director for VistaCare VistaCare has provided commercial support for
Dyspnea: The top things you need to you know! Dr. Megan Sellick & Dr. Lawrence Lee Edmonton Zone Palliative Care Program
: The top things you need to you know! Dr. Megan Sellick & Dr. Lawrence Lee Edmonton Zone Palliative Care Program Faculty / Presenter Disclosure Faculty: Dr. Lawrence Lee Relationships with commercial
A SLP s Guide to Medication Therapy and Management. Sarah Luby, PharmD, BCPS KSHA 2017
A SLP s Guide to Medication Therapy and Management Sarah Luby, PharmD, BCPS KSHA 2017 Objectives Identify the appropriate route of administration for medications and proper formulations for use Understand
Symptom Management in the Non-Verbal Patient at the End of Life Laura Carmon, ANP-BC
Symptom Management in the Non-Verbal Patient at the End of Life Laura Carmon, ANP-BC 2017 NPSS Asheville, NC Objectives The learner will recognize non-verbal signs and symptoms commonly seen at the EOL.
Burt. Symptom Management 11/7/2016. Always looking for lowest dose to achieve symptom management to limit side effects
Francine Arneson, MD Palliative Medicine Medical Director Burt 72 year old male with a history of DM, HTN, and CKD Creatinine 2.1 baseline History of smoking Presented with cough, severe back pain Workup
Managing Respiratory Symptoms - Breathlessness, Cough and Secretions. Dr Laura Healy. Palliative Medicine Registrar, Beaumont Hospital.
Managing Respiratory Symptoms - Breathlessness, Cough and Secretions. Dr Laura Healy. Palliative Medicine Registrar, Beaumont Hospital. Things to consider: 1. Very common symptoms. 2. Can occur in any
Palliative Emergencies. Ken Stakiw
Palliative Emergencies Ken Stakiw Disclosure None to disclose for this lecture Have received honoraria from a number of agencies and companies previously Intend to discuss some off label use of medications
Pharmacy Benefit Determination Policy
Policy Subject: Opioid Induced Constipation Policy Number: SHS PBD11 Category: GI Agents Policy Type: Medical Pharmacy Department: Pharmacy Product (check all that apply): Group HMO/POS Individual HMO/POS
GI Pharmacology -4 Irritable Bowel Syndrome and Antiemetics. Dr. Alia Shatanawi
GI Pharmacology -4 Irritable Bowel Syndrome and Antiemetics Dr. Alia Shatanawi 11-04-2018 Drugs used in Irritable Bowel Syndrome Idiopathic, chronic, relapsing disorder characterized by abdominal discomfort
Dyspnea: Evaluation and Management
Dyspnea: Evaluation and Management Sandra Whitlock, M.D. Four Seasons Palliative Care Course Handouts & Post Test o To download presentation handouts, click on the attachment icon o Presenter discloses
Medications used for symptom control in palliative care
Learning Objectives used for symptom control in palliative care Luis Viana, R. Ph., M.Ed., CGP 1. For common symptoms experienced by the person managed with palliative care: Recognize the symptom to be
PAIN MANAGEMENT PGY-1. Aaron D. Storms, MD Carin van Zyl, MD Adult and Pediatric Palliative Care, LAC+USC Keck School of Medicine of USC
PAIN MANAGEMENT PGY-1 Aaron D. Storms, MD Carin van Zyl, MD Adult and Pediatric Palliative Care, LAC+USC Keck School of Medicine of USC Perception Matters A builder aged 29 came to the accident and emergency
Symptom Management for Patients Near End of Life
Symptom Management for Patients Near the End of Life Ritchell R. Dignam, MD Medical Director Vitas Healthcare 856-778-0222 Objectives Review the etiology and pathophysiology of common non-pain symptoms
Hospice High Dollar Medications and Possible Alternatives
Hospice High Dollar Medications and Possible Alternatives Ly M. Dang, PharmD LDang@HospicePharmacySolutions.com Director of Pharmacy Operations Hospice Pharmacy Solutions Topics of Discussion Hospice Coverage
This survey aims to look at individual practice and can be completed by any healthcare professional.
This survey aims to look at individual practice and can be completed by any healthcare professional. If you have any questions about how this form should be completed please contact Dr Grace Ting (ghlting@doctors.net.uk)
Methadone Maintenance: safe and effective opioid pharmacotherapy. Karen Miotto, MD UCLA Department of Psychiatry
Methadone Maintenance: safe and effective opioid pharmacotherapy Karen Miotto, MD UCLA Department of Psychiatry Opioid abuse and dependence statistics, 2007 Persons who reported abuse or dependence in
GUIDELINES & PROTOCOLS
GUIDELINES & PROTOCOLS ADVISORY COMMITTEE Palliative Care for the Patient with Incurable Cancer or Advanced Disease Part 2: Pain and Symptom Management Dyspnea Effective Date: September 30, 2011 Scope
daily; available as 10- mg g PO
Overview of the PRN: The Pain and Palliative Care PRN of ACCP is an organization of pharmacy practitioners, clinical scientists, pharmacy educators, and others. Its mission is to advance pain and palliative
(D) Standard Indications Included (Refer to Appendix A for list of medications)
Name of Policy:PolicyNumber: PRN Indications }-.+-`-+,tr---fi::-'..1- :-` -.,-_ -` E-..,',,=.:~1,EffectiveDate:9/1/2018 Department: ApprovlnResponslScope: g Officer:bleAgent: 3364-133-103 Pharmacy Chief
Five Centers of Nausea. Linda Tavel, MD Program Medical Director VistaCare Hospice
Five Centers of Nausea Linda Tavel, MD Program Medical Director VistaCare Hospice Objectives Prevalence of nausea and vomiting Anatomic and physiologic paths to nausea Evaluation of nausea Treatment of
Waterloo Wellington (WW) Symptom Management Guideline for the End of Life (EOL) Medication Order Set for Long Term Care (LTC)
Waterloo Wellington (WW) Symptom Management Guideline for the End of Life (EOL) Medication Order Set for Long Term Care (LTC) May 2018 THE WATERLOO WELLINGTON SYMPTOM MANAGEMENT GUIDELINE FOR THE END OF
Symptom Management. Thomas McKain, MD, ABFM, ABHPM Medical Director
Symptom Management Nausea & Vomiting Thomas McKain, MD, ABFM, ABHPM Medical Director Mr. Jones has nausea and vomiting. May I initiate Compazine from the Comfort Pak? Objectives 1. Delineate the Differential
Palliative Care Pearls: What Works, What Doesn t
: Steven Pantilat, MD Kates-Burnard and Hellman Distinguished Professor of Palliative Care Director, Palliative Care Program and Palliative Care Quality Network Department of Medicine University of California,
PEDIATRIC SPINE SURGERY POST-OP PLAN - Phase: Pediatric Spine Surgery General Orders
- Phase: Pediatric Spine Surgery General Orders PHYSICIAN S Diagnosis Weight Allergies Patient Care Patient Activity Bedrest Maintain Surgical Drain Maintain JP Drain, Measure Output q12h, and PRN Convert
Palliative Care Drug Plan (Plan P) Formulary List of drugs PharmaCare covers
Palliative Care Drug Plan (Plan P) Formulary List of drugs PharmaCare covers This formulary is current as of February 11, 2010. Important Notes: Pharmacists must submit a claim on PharmaNet at the time
Regional Breathlessness Audit - Case Note Survey. 1. Introduction. Regional Breathlessness Audit - Case Note Survey. 2.
Regional Breathlessness Audit - Case te Survey 1. Introduction Please complete this form for your case note review. Cases used may be PROSPECTIVE AND/OR RETROSPECTIVE. Please log as many cases as you can.
PAIN MANAGEMENT Person established taking oral morphine or opioid naive.
PAIN MANAGEMENT Person established taking oral morphine or opioid naive. Important; it is the responsibility of the prescriber to ensure that guidelines are followed when prescribing opioids. Every member
EPIDURAL / INTRATHECAL POST-OP PLAN
EPIDURAL / INTRATHECAL POST-OP PLAN Diagnosis Weight PHYSICIAN S Allergies Patient Care Vital Signs Per Unit Standards, PLUS check and record RR q1h x 12, then q2h x 6, until 24h following narcotic administration.
Antidiarrheals Antidiarrheal
Antidiarrheals Major factors in diarrhea Increased motility of the GI tract. Decreased absorption of fluid. Antidiarrheal drugs include: Antimotility agents. Adsorbents. Drugs that modify fluid and electrolyte
We would like to thank you for completing this audit questionnaire which looks at how you manage nausea and vomiting in palliative care patients.
We would like to thank you for completing this audit questionnaire which looks at how you manage nausea and vomiting in palliative care patients. The closing date for responses is 19th December The results
Opioids: Safe Use and Side Effects
Opioids: Safe Use and Side Effects Your doctor has prescribed an opioid (OHpee-oyd). This drug can control moderate to severe pain without increased risk of bleeding and kidney problems. Always take the
Palliative Care. e CHAPTER 9 DEFINITIONS INTRODUCTION KEY CONCEPTS. Jill Astolfi
Palliative Care Jill Astolfi e CHAPTER 9 KEY CONCEPTS 2 3 4 5 6 7 The goal of palliative care is to improve overall quality of life for patients, caregivers, and families while managing both general and
10 mg hydrocodone equals how much oxycodone
Cari untuk: Cari Cari 10 mg hydrocodone equals how much oxycodone Posts about dilaudid 8 vs oxycodone 30 written by buyprescriptionmedication. Can you help me with the conversion of Oxycodone IR (5mg tab)
Morphine Sulfate Hydromorphone Oxymorphone
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.02.33 Subject: Morphine Drug Class Page: 1 of 8 Last Review Date: June 19, 2015 Morphine Sulfate Hydromorphone
CENTENE PHARMACY AND THERAPEUTICS DRUG REVIEW 3Q17 July August
BRAND NAME Symproic GENERIC NAME Naldemedine MANUFACTURER Shionogi Inc. DATE OF APPROVAL March 23, 2017 PRODUCT LAUNCH DATE Anticipated to launch mid-summer 2017 REVIEW TYPE Review type 1 (RT1): New Drug
Opioid constipation treatment dulcolax
P ford residence southampton, ny Opioid constipation treatment dulcolax Posts about how to relieve constipation instantly written by gbrese1958. Official Web site for MOVANTIK (naloxegol) tablets, for
GUIDELINES ON THE MANAGEMENT OF PAIN DUE TO CANCER IN ADULTS
GUIDELINES ON THE MANAGEMENT OF PAIN DUE TO CANCER IN ADULTS Bristol Palliative Care Collaborative Contact Numbers: Hospital Specialist Palliative Care Teams: North Bristol 0117 4146392 UH Bristol 0117
National Council on Patient Information and Education
National Council on Patient Information and Education You are not alone The type of pain that caused your doctor to prescribe a pain medicine for you can make you feel that you are different from everyone
Objectives: What is your Definition of Pain? 8/16/2017
Safe Opioid Management for the Seriously Ill Patient Sam Perna, D.O. Objectives: MDB1 1) Participants will understand the way the body s pain system works. 2) Participants will identify the elements of
Review of Pain Management with Clinical and Regulatory Updates
Review of Pain Management with Clinical and Regulatory Updates Palliative Care Collaborative: 8 th Annual Regional Conference October 10, 2014 Michael Stellini, M.D.,M.S. Medical Director, Hospice and
Drugs Affecting the Gastrointestinal System. Antidiarrheal and Laxatives
Drugs Affecting the Gastrointestinal System Antidiarrheal and Laxatives Diarrhea Abnormal frequent passage of loose stools or Abnormal passage of stools with increased frequency, fluidity, and weight,
Efficacy and Safety of Lubiprostone. Laura Wozniak February 23, 2010 K30 Monthly Journal Club
Efficacy and Safety of Lubiprostone Laura Wozniak February 23, 2010 K30 Monthly Journal Club Objectives Brief overview of constipation Review of article Discussion Constipation in Children 3-5% of all
ENT THYROIDECTOMY/PARATHYROIDECTOMY POST OP PLAN - Phase: Begin Immediately/PACU
- Phase: Begin Immediately/PACU PHYSICIAN S Diagnosis Weight Allergies Laboratory Calcium Level STAT Outpatient/PACU, T;N PTH Intact STAT Outpatient/PACU, T;N 1 of 7 - Phase: When Patient Arrives to Room
BASICS OF OPIOID PRESCRIBING 10:30-11:45AM
PROVIDING QUALITY CARE TO PAIN PATIENTS IN IOWA BASICS OF OPIOID PRESCRIBING 10:30-11:45AM ACPE UAN: 107-000-14-013-L01-P Activity Type: Application-Based 0.125 CEU/1.25hr Learning Objectives for Pharmacists:
Palliative Medicine Overview. Francine Arneson, MD Palliative Medicine
Palliative Medicine Overview Francine Arneson, MD Palliative Medicine Palliative Medicine: Definition Palliative care: An approach that improves the quality of life of patients and their families facing
PEDIATRIC SPINE SURGERY POST-OP PLAN - Phase:.
- Phase:. PHYSICIAN S Diagnosis Weight Allergies DETAILS Patient Care Patient Activity Bedrest Maintain Surgical Drain Maintain JP Drain, Measure Output q12h, and PRN Convert IV to INT when tolerating
UMC Health System Patient Label Here. PHYSICIAN ORDERS Diagnosis
Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards q12h q12h, Temperature Only - Every Shift and PRN Patient Activity Assist as Needed, Bed Position: As Tolerated, elevate to patient
Pain Management in the Hospital
E P E C O Pain Management in the Hospital Denise Waugh, MD FACEP FAAHPM Medical Director of Palliative Care Services Scott and White Healthcare 724-6859 Pain is a more terrible lord of mankind than even
Constipation: Assessment and Management
Constipation: Assessment and Management Page 1 of 8 Table of Contents Introduction for the Learner (Resident/Oncology Fellow).............................................. 2 Introduction for Clinical Faculty
morphine 30 mg/ 30 ml (1 mg/ml) Opioid of choice
PATIENT CONTROLLED ANALGESIA (PCA) PLAN Allergies: Medication Selection: morphine 30 mg/ 30 ml (1 mg/ml) Opioid of choice HYDROmorphone (Dilaudid ) 6 mg/ 30 ml (0.2 mg/ml) fentanyl 300 mcg/ 30 ml (10 mcg/ml)
PAIN MANAGEMENT Patient established on oral morphine or opioid naive.
PAIN MANAGEMENT Patient established on oral morphine or opioid naive. Important; It is the responsibility of the prescriber to ensure that guidelines are followed when prescribing opioids. Every member
Advances in Palliative Care
Steven Pantilat, MD Professor of Clinical Medicine Alan M. Kates and John M. Burnard Endowed Chair in Palliative Care Director, Palliative Care Program and Palliative Care Leadership Center Division of
Pain Management A guide for patients
Patient Education Patient Care Services Management A guide for patients Most pain can be managed with medicine and other treatments. This guide gives information about controlling pain and talking with
Conversion from oxycodone to ms contin
Search for: Search Search Conversion from oxycodone to ms contin Opioid Dose Converter. Enter 24-hour total doses below, then click the convert button to display 24-hour equianalgesic. Oxycodone SC. mg.
A patient s guide to the. management of constipation following surgery
A patient s guide to the management of constipation following surgery This leaflet has been designed to give you more information about using laxatives after your surgery. What is constipation? After your
Drugs Affecting the Gastrointestinal System. Antacids, Constipation, Increasing gastrointestinal motility
Drugs Affecting the Gastrointestinal System Antacids, Constipation, Increasing gastrointestinal motility Cells of the Gastric Gland parietal cells: produce & secrete HCl primary site of action for many
Coleman Supportive Oncology Initiative Palliative Training Module Topic: Pain Management: The Basics
Coleman Supportive Oncology Initiative Palliative Training Module Topic: Pain Management: The Basics Presenters: Shelly Lo, MD and Joanna Martin, MD; updated by Christine B. Weldon, MBA and Betty Roggenkamp,
Sam H Ahmedzai Academic Unit of Supportive Care Department of Oncology The University of Sheffield & Sheffield Teaching Hospitals NHS Foundation
Sam H Ahmedzai Academic Unit of Supportive Care Department of Oncology The University of Sheffield & Sheffield Teaching Hospitals NHS Foundation Trust Overview Which drugs? How much? How to give? Adverse
ENT THYROIDECTOMY/PARATHYROIDECTOMY POST OP ADMIT PLAN - Phase: Begin Immediately/PACU
- Phase: Begin Immediately/PACU Diagnosis Weight Allergies DETAILS Admit/Discharge/Transfer Patient Status Pt Status: Inpatient (LOS > 2 midnights) Pt Status: Observation (LOS < 2 midnights) Pt Status:
UMC Health System Patient Label Here PHYSICIAN ORDERS
Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards q12h q12h, Temperature Only - Every Shift and PRN Patient Activity Assist as Needed, Bed Position: As Tolerated, elevate to patient
RELISTOR (methylnaltrexone bromide) INJECTION FOR SUBCUTANEOUS USE
RELISTOR (methylnaltrexone bromide) INJECTION FOR SUBCUTANEOUS USE Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for
Protocol to support reducing the use of and the effective use of laxatives. HaRD CCG employed Pharmacists and Medicines Optimisation Technicians.
NY&AWC Medicines Management Team Protocol to support reducing the use of and the effective use of laxatives Applies to HaRD CCG employed Pharmacists and Medicines Optimisation Technicians. These protocols
Equianalgesic Dosing: Making Opioid Interchange Easier. Joseph Bubalo PharmD, BCPS, BCOP Oncology Clinical Pharmacist Assistant Professor Of Medicine
Equianalgesic Dosing: Making Opioid Interchange Easier Joseph Bubalo PharmD, BCPS, BCOP Oncology Clinical Pharmacist Assistant Professor Of Medicine 1 Why Change Opioids? Side Effects Insufficient Pain
Syringe driver in Palliative Care
Syringe driver in Palliative Care Introduction: Syringe drivers are portable, battery operated devices widely used in palliative care to deliver medication as a continuous subcutaneous infusion over 24
Constipation. Self-study course
Constipation Self-study course 2 Course objectives: At the end of this course you will be able to: 1. Define the term constipation 2. Explain three reasons why older adults are at greater risk for constipation
TRANSPARENCY COMMITTEE OPINION. 10 December 2008
The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 10 December 2008 RELISTOR 12 mg/0.6 ml solution for injection 1 vial (CIP: 387 365-1) 2 vials + 2 sterile syringes
Symptom Management Challenges at End-of-Life
Symptom Management Challenges at End-of-Life Amanda Lovell, PharmD, BCGP Clinical Pharmacist- Inpatient Units Optum Hospice Pharmacy Services February 15, 2018 Hospice Pharmacy Services Objectives Identify
SYMPROIC (naldemedine tosylate) oral capsule
SYMPROIC (naldemedine tosylate) oral capsule Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This
Overview of Essentials of Pain Management. Updated 11/2016
0 Overview of Essentials of Pain Management Updated 11/2016 1 Overview of Essentials of Pain Management 1. Assess pain intensity on a 0 10 scale in which 0 = no pain at all and 10 = the worst pain imaginable.
LYSIS OF ADHESIONS POST-OP PLAN - Phase: PACU Phase
- Phase: PACU Phase PHYSICIAN S Diagnosis Weight Allergies Communication Place Device at Bedside Confirm there are 3 x Aliquots of 0.2% Ropivacaine. 2 x Medfusion Infusion pumps. Confirm 3 x PF Aliquots
Constipation. Myeloma Infosheet Series. Symptoms and complications. Infoline:
Constipation This Infosheet explains what constipation is, what causes it in myeloma patients, what the symptoms of it are, how it is treated and some tips for self-management. What is constipation? Constipation
End Stage Liver Disease Regional Audit Casenote Survey
1. This questionnaire is an audit of clinical documentation of patients who have died of end stage liver disease. If you have any questions about how this form should be completed please contact Dr Grace
I M NOT AFRAID TO. Quality of Life at the End of Life: Hospice, Ethics, Palliative Care 4/18/2018 I JUST DON T WANT TO BE THERE WHEN IT HAPPENS
Quality of Life at the End of Life: Hospice, Ethics, Palliative Care I M NOT AFRAID TO DIE I JUST DON T WANT TO BE THERE WHEN IT HAPPENS WOODY ALLEN 1 PRINCIPLES OF ETHICS Beneficence- doing more good
4/18/2018. Quality of Life at the End of Life: Hospice, Ethics, Palliative Care
Quality of Life at the End of Life: Hospice, Ethics, Palliative Care 1 I M NOT AFRAID TO DIE I JUST DON T WANT TO BE THERE WHEN IT HAPPENS WOODY ALLEN 2 PRINCIPLES OF ETHICS Beneficence- doing more good
Palliative and Hospice Care of the Terminally Ill Introduction
Palliative and Hospice Care of the Terminally Ill Introduction There has been an increase in life expectancy for men and women of all races to 77.6 years Leading causes of death in older patients are chronic
Primary Care Constipation Guidelines. Version 1 November 2016
Primary Care Constipation Guidelines Version 1 November 2016 VERSION CONTROL Version Date Amendments made Version 1 November 2016 New guideline Contents 1. Management of constipation in adults: acute and
Medications and ostomies. Sarah Drost, BSc Pharm, RPh, ACPR
Medications and ostomies Sarah Drost, BSc Pharm, RPh, ACPR Overview 1. Medication absorption 2. Medication forms 1. Oral medications 2. Non-oral medication routes 3. Monitoring medications 4. Specific
PAIN MANAGEMENT 101. By: Vicki McCulloch RN, NP & DeAnna Looper RN, CHPN, CHPCA
PAIN MANAGEMENT 101 By: Vicki McCulloch RN, NP & DeAnna Looper RN, CHPN, CHPCA Objectives Identify a step-wise approach to pain management. Identify the WHO Pain Ladder. Identify non-pharmacological pain
GASTROINTESTINAL MEDICATIONS By: Jerald S. Ugdoracion, RN, MN-MS
GASTROINTESTINAL MEDICATIONS By: Jerald S. Ugdoracion, RN, MN-MS Reviewing these things may help you in understanding better how gastrointestinal medications alleviate problems of the GI tract: a. Review
Page 1 of 8. 7 SICKNESS AND HEALTH 7.1. chronic diseases and quality of life
Page 1 of 8 7 SICKNESS AND HEALTH 7.1. chronic diseases and quality of life Illnesses are classified as either acute or chronic. An acute illness lasts for a short period of time and may go away without
Protectives and Adsorbents. Inorganic chemistry Course 1 Third year Assist. Lecturer Ahlam A. Shafeeq MSc. Pharmaceutical chemistry
Protectives and Adsorbents Inorganic chemistry Course 1 Third year 2016-2017 Assist. Lecturer Ahlam A. Shafeeq MSc. Pharmaceutical chemistry Protectives and Adsorbents This group of gastrointestinal agents
Respiratory Issues at End-of-Life. Jerry Boltz, FNP January 27, L N E C Geriatric Curriculum
Respiratory Issues at nd-of-life Jerry Boltz, FNP January 27, 2012 L N C Geriatric Curriculum nd-of-life Nursing ducation Consortium Module 3: Nonpain Symptoms at the nd of Life Part I Common Respiratory
Palliative Medicine in Critical Care Not Just Hospice. Robin. Truth or Myth 6/11/2015. Francine Arneson, MD Palliative Medicine
Palliative Medicine in Critical Care Not Just Hospice Francine Arneson, MD Palliative Medicine Robin 45 year old female married, husband in Afghanistan. 4 children ages 17-24. Mother has been providing