APRIL 2019 NEWSLETTER

APRIL 2019 NEWSLETTER

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PDCRx APRIL 2019 NEWSLETTER

Did You Know…

Local Pharmacy

Did you know that Palliative Drug Care prefers local pharmacies?


PDCRx believes in paying the pharmacy fairly as well as building a connection with the pharmacy.

We have worked with pharmacies across the country and have been referred by such pharmacies to hospices nationwide time and time again. PDCRx is not limited by the current pharmacies we have in our network and has the ability to increase our network of available pharmacies for your hospice. We are open, willing, and excited to working with all pharmacies as we, as well as your hospice, grow. We will work with you to select the best pharmacy options as well as the best pharmacy charges.
 

Do you have a topic for Clinical Material that you would like to see covered? Contact: Taylor Bradshaw at taylor@pdcrx.com
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Clinical Pearl…

How Can We Contain Non-Hospice Scripts

Does your hospice have problems when working with Facilities and what process do you have for fixing it?…

Have you ever experienced this scenario:
It’s time to review your hospice invoice and notice that your COPD patient in the long-term care facility has apparently been ordered non-hospice covered medications that aren’t congruent with the Hospice Plan of Care related to the patient’s terminal lung condition…

Continue Reading…
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MEET OUR STAFF
Melody Myers
Meet
Melody Myers

Clinical Assistant

Meet our wonderful Melody! She has been a crucial piece of the PDC team since 2010. Throughout this time, she has learned a lot about the company, and she looks forward to continuing her growth with PDC while investing her time into its future. She was first a huge help on our PDC Customer Service Team, and now she is now a Clinical Assistant to our Doctor of Pharmacy. Mel, as we like to call her, was born and raised in Tulsa, Oklahoma. She graduated from Memorial High School. She has a wonderful daughter and is a proud grandmother of two grandkids, both girls. In her spare time, she enjoys reading a good book, dancing, and hanging out with friends and family. A fun fact about Mel is that her family is a descendent of the great novelist, Nathanial Hawthorne.

Thank you for all that you do Melody! We sure appreciate you!

Just For Fun…

Are you having a hard time coping with the hospice journey?

Whether you are a hospice nurse, someone that was recently diagnosed, a patient currently in hospice or about to be, or a family member trying to cope through this time- no matter where you find yourself in the hospice journey... these should be comforting resources.
 
  • When Breath Becomes Air by Paul Kalanithi
    • This book is a memoir written by a young neurosurgeon faced with a terminal cancer diagnosis who attempts to answer the question, “What makes a life worth living?”
 
  • Being Mortal: Medicine and What Matters in the End by Atul Gawande
    • Here is a great read for hospice staff. Gawande, a practicing surgeon, addresses his profession's ultimate limitation, arguing that quality of life is the desired goal for patients and families.
 
 
 

Where Will PDC Be This Month?

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Copyright © 2018, All rights reserved.

Our mailing address is:
Palliative Drug Care
130 N. Greenwood Ave.
Suite 200
Tulsa, OK 74120

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MARCH 2019 NEWSLETTER

MARCH 2019 NEWSLETTER

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PDCRx MARCH 2019 NEWSLETTER

Did You Know…

Did you know that PDCRx provides Clinical Material for you and your hospice team?


In each newsletter we produce, we include a “Clinical Pearl” or educational material covering a wide range of topics. We then turn the Clinical Pearl into a PowerPoint that can be easily shared with your hospice team to further education. Developed by the PDCRx Clinical Team, these resources are readily available at your fingertips through your PDC Shared Work account.
We are constantly looking for feedback and/or topics that you would like to see covered or that you think your hospice would benefit further from.

Here is a list of Clinical Material that we have already prepared:

•    How to Have the Difficult Conversations
•    Do We Still Need All of These Meds?
•    Everybody Gets A Zofran!! But should they…
•    Pain Management and Opioids
•    Methadone Utilization
•    Deciding Appropriate Medications for End of Life


Would you like access to these but don’t have a Shared Work account? Or, do you have a topic for Clinical Material that you would like to see covered? Contact: Taylor Bradshaw at taylor@pdcrx.com
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Clinical Pearl…

What is “Total Pain”?…

Ever had a patient who you felt you had to continually go up and up and up on the pain and anxiety meds? Well…there is a good chance the “pain” is not just physical pain. According to Dame Cicely Saunders, there are multiple facets of pain that can all manifest in the form of physical pain:

1.    Psychological …
2.    Spiritual …
3.    Social …
4.    Physical …

Continue Reading…
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MEET OUR STAFF
Meet
Louise Jordan

Pharmacy Developement & Operations Specialist
 
Louise is a mother of 1 beautiful daughter (Kathrine) and grandmother of 3 very handsome boys (Braiden 3, Eli 1 and the newest addition Isaac 2 weeks old) and 1 dog Babi who thinks he owns the house and everything in it!!!
Louise started as a Customer Service Rep after a year was offered the position of Customer Service Manager, which she gladly accepted, after 5 years of it she was ready for a change, she is now the Pharmacy Development & Operations Specialist.  Louise has been with PDC for approximately 7 years, she is originally from Canada…yes PDC loves Canadians.  She is from Gatineau, Québec, her first language is French and yes, she, like Brent loves Tim Horton coffee and donuts.  What brought her to Tulsa, OK you ask…her husband Philip.  They met more than 20 years ago and will be married 19 years in July.

In her spare time Louise loves to spend time with her family, loves to cook and share recipes.
 

Just For Fun…

Where Will PDC Be This Month?

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Copyright © 2018, All rights reserved.

Our mailing address is:
Palliative Drug Care
130 N. Greenwood Ave.
Suite 200
Tulsa, OK 74120

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You can update your preferences or unsubscribe from this list

What is “Total Pain”?

What is “Total Pain”?

What is “Total Pain”?

Ever had a patient who you felt you had to continually go up and up and up on the pain and anxiety meds? Well…there is a good chance the “pain” is not just physical pain.

FEBRUARY 2019 NEWSLETTER

FEBRUARY 2019 NEWSLETTER

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PDCRx FEBRUARY 2019 NEWSLETTER

Did You Know…

PDCRx Fun Lady Image
Did you know that there is a meaning behind the PDC Fun Lady/mascot?

At Palliative Drug Care, we always keep the patient in mind. Many of our employees have either worked one-on-one with patients in palliative care or have had a family member in hospice. Life will end for all of us at some point, as harsh as that may sound, but that is why it is called the “circle of life”. To us, this lady represents someone who enjoys their final years, their final days. We may not all be able to dance around, some of us may not be able to remember, and others of us will need constant monitoring. We don’t all end up in the same mental and physical state during our final days, but we will all want a level of care that makes us feel like this lady looks. She looks happy and she looks cared for.


For more information, contact
Taylor Bradshaw at taylor@pdcrx.com
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www.PDCRx.com

Clinical Pearl…

Difficult Conversations Image
How to Have the Difficult Conversations…
Do you understand the difference between palliative care and hospice? If not, let me give the quick schpeel, then I’ll talk more about how to have these super hard discussions regarding a patient diagnosis, prognosis, etc.

Palliative care is the aggressive symptom management for anyone with a chronic or severe illness. With that being said, all hospice care is palliative care, but not all palliative care is hospice. This means that you can STILL be receiving palliative care (aggressive symptom management) even while aggressively treating your chronic or terminal illness. An example of this would be a cancer patient who is wanting to continue to pursue chemo/radiation treatments, but needs more assistance with symptoms – in walks palliative care!


Continue Reading…
Read Full Article
MEET OUR STAFF
Mark and his wife Sara Image
Mark with his wife Sara

Meet
Mark Lewandowski,
Ph.D.
Executive Vice President and Co-Founder
 
Mark Lewandowski started his career at age 16 learning to sell expensive custom suits from one of the great clothiers of his time.  Frustrated with working for minimum wage and making other people rich, Mark and his college roommate started a window cleaning business that still remains today.  While running the window cleaning company for 8 years, Mark learned the art of closing the sale and leveraging relationships to radically grow small business.  IBM called and Mark took a job in Sales in 1988 which proved only that he was not meant for big corporate crap.  
While working in his 20s, Mark completed an MBA and a Ph.D. in Management with an emphasis in Idea Generation and Creativity.  Mark was lucky enough to be mentored by great minds such as: Gene Swearingen, Rinne Martin, Harry Coblenz and business leaders such as Jim Bigl, Mark Wright, Bert Brodsky, and Jeff Walker.  

Mark knew that to achieve his life goals he needed to continue specialized education beyond the doctoral work.  He did his Certified Mergers and Acquisitions Advisor credential at Loyola of Chicago and at age 51 completed the Innovation and Entrepreneurship Program from the Stanford University.
Using life experiences, education and great mentors to his advantage Mark has served in leadership roles at Interchange PMP as President, NMHCRX as Senior Vice President, and currently is serving as CEO for three companies in the healthcare claims processing space.  

Mark’s passion is teaching and leading brilliant minds to discover the secrets of business success through the Mind Your Business Show radio show and his Podcast at DRMARKLEW.COM.
 
Just For Fun…

Love Stories…

It was a beautiful springtime day, the birds were chirping melodious sonnets, whimsically dancing through the effervescent sky. A homeless man resembling a pied piper lead me to the magical land called Reasors—a beautiful oasis with all of life’s needs in the desert landscape we call Tulsa. The produce isle called to me like a siren to Homer. As it turned out, that wasn’t the isle calling me, it was an angel sent from above. Named Angel. As I couldn’t help but lock eye’s with her pulchritudinous eyes that dazzled the room and her captivating smile that would warm you up on a cold day in Chicago. It was at that instant that I believed in love at first sight. Cupid had struck me with his arrow.
JMac and Angel
Jonathan McIntosh
 


We met when I was probably 5 years old, not knowing I would fall madly in love with him, because my sister and I would always go over to our cousins (Jordan & Brennen + their brother) and play outside! He lives about 4 houses down from them—at the end of the street, while my cousins were in the middle of the cul-de-sac. Fast forward 12 years and I see him at the high school I transferred to my junior year! We recognized each other and it started our friendship back over after all the years. Towards the middle of basketball season we started dating, but sadly broke up 3 months later, due to him going off to college. We only dated for a couple months, but my heart was so broken and I had no clue why…little did I know God had something better in store for us! As time went by, before I knew it, I was graduating high school and planning to play college basketball in Kansas at a school that just so happens to be an hour away from him. Summer of 2014 started off very rocky due to a break up with my, then, boyfriend but in comes Jordan guns blazing hahah! We started talking again and on November 22nd, 2014 he asked me to be his girlfriend. We have been together ever since and I can’t imagine my life without him ❤ Side note/super cheesy note: he chose 11/22 because he knows those are my favorite numbers.  We ALWAYS write notes to each other for Valentine’s day and save them for our future old selves to read later on in life.                
Ashlyn and Jordan
Ashlyn McBride
 

Jason (my then boyfriend of 10 months) asked me to come pick him up from class at Oklahoma State University after he was finishing a GIS project. I honked at him, because it was October and cold. He then came to the door of the car, all dressed up, and asked me to walk with him. It was just after dusk and he walked me to the front of the Student Union at OSU (where they was incredible lighting and beautiful landscaping) where he asked me to go open a large box. I did, and there was a tiny, baby chocolate lab puppy! I was ecstatic…but when I held her up to the light to get a better look, I saw a diamond ring and turned around to see him kneeling then he asked me to marry him. We then got married 4 weeks later with an ice chest of Coors Light surrounded by our closest friends and family. It’s now been 13+ years.
Jaymie and Jason
– Jaymie Wilson
Where Will PDC Be This Month?
PDC JOIN US here in Feb
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Copyright © 2018, All rights reserved.

Our mailing address is:
Palliative Drug Care
130 N. Greenwood Ave.
Suite 200
Tulsa, OK 74120

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How to Have the Difficult Conversations…

How to Have the Difficult Conversations…

 

Do you understand the difference between palliative care and hospice? If not, let me give the quick schpeel, then I’ll talk more about how to have these super hard discussions regarding a patient diagnosis, prognosis, etc.

 
The patient will be treated not only for his or her physical symptoms, but also spiritual, social, and psychological symptoms.
— Dame Cicely Saunders
shutterstock_296282765.jpg

Palliative care is the aggressive symptom management for anyone with a chronic or severe illness. With that being said, all hospice care is palliative care, but not all palliative care is hospice. This means that you can STILL be receiving palliative care (aggressive symptom management) even while aggressively treating your chronic or terminal illness. An example of this would be a cancer patient who is wanting to continue to pursue chemo/radiation treatments, but needs more assistance with symptoms – in walks palliative care! However, if they choose hospice, they then forgo any continue chemo/radiation as they have chosen the season of life where curative treatment is no longer the goal, but rather symptom management and quality of life. It is also extremely important to note that in both palliative and hospice care, the patient will be treated not only for his or her physical symptoms, but also spiritual, social, and psychological symptoms. (Check out Dame Cicely Saunders concept of “total pain”…it’s genius)

Because of this, the conversations in palliative care can be much more difficult than those with hospice care due to the fact that often times once a patient has chosen to see hospice, they understand (for the most part) that they are extremely ill and pursuing care at the end of their life. However, having the conversations in palliative care, before they understand the severity of their disease or illness, is a whole new level of difficult, sad, awkward, and awful.

Some rules of thumb, before we get into the real nitty-gritty details are this:

1.     Terminology is key! Not everyone understands lingo like “stage 4”, “terminal” or “malignant” so always try to talk about things on more of a human level and less of a medical level. NEVER speak in a way with medical lingo that can be viewed as speaking down to them.

2.     Speak to them as you would want someone to speak to your mother, brother, father, or child. Again, remove some of the medical sterility in the conversation. You’re about to share with them possibly earth-shattering news.

3.     Always start by finding out what they know. You might be surprised to find out that they actually have a very minimal understanding of their illness. Often times, it’s either because no one knew had to tell them (or didn’t want to yet to avoid the patient “giving up hope”) or told them is medical terms and therefore the patient didn’t have a good understanding and was too embarrassed or shocked to ask questions for clarification.

4.     Then, ask what they want to know. Separate your views from the patients for a second – not everyone wants to know exactly where they are headed. On the flip side, some people want to know every single detail that you can share.

Now that you have a basis of understanding how to begin the conversation, let’s dive deeper with the help of the
SPIKES protocol, as laid out by Baile et al. (2000):

1.     Step 1: “S” – setting up the interview

a.     Arrange for privacy, only including those whom the patient wants involved.

b.     Make sure it a comfortable setting with seating.

2.    Step 2: “P” – Assessing the patient’s Perception

a.     Just as discussed previously, ask them what they know so you know what gaps you’ll need to fill in for the discussion.

3.     Step 3: “I” – Obtaining the patient Invitation

a.     What do they want to know? Do they want to know everything now, or just partial information with a follow up meeting?

4.     Step 4: “K” – Giving Knowledge

a.     In case the patient doesn’t understand that the conversation is leading to bad news, you can start by saying “ Unfortunately, …” or “I’m sorry to tell you…”.

b.     **Never say – “There is nothing more we can do for you.”** Because there is always more you can do that would be more in line with the patient’s therapeutic goals, such as good pain control and symptom relief.

5.     Step 5: “E” – Addressing the patient’s Emotions

a.     Offer empathy.

6.     Step 6: “S” – Strategy and Summary

a.     Ask for any final questions.

b.     Often, it’s good to ask them if they want to think about things and discuss it among themselves, then ask if they’d like a follow up meeting to go over more the plan and how they’d like to pursue treatment. Also, this will give them more time to come up with other questions, as they are often is a state of shock for quite a while.



So, of course, this is all easier said that done. However, just remember to speak to them as a human and how you would want someone to talk to you or your family to deliver this news. Then always offer support and availability to answer questions.

 

Jaymie Wilson, APRN-CNP, ACHPN

 



Reference:

Baile, W., Buckman, R., Lenzi, R., Glober, G., Beale, E., & Kudelka, A. (2000). SPIKES – A six-step protocol for delivering bad news: application to the patient with cancer. The Oncologist, 5(4), 302-311.

 

JANUARY 2019 NEWSLETTER

JANUARY 2019 NEWSLETTER

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PDCRx JANUARY 2019 NEWSLETTER

Did You Know…

PDC has been helping hospices all over the nation… for 20 years!!

As one of the very last family-owned and operated hospice claims processors, PDC continues to thrive. It was 2001 when our founders (Paul Hagen & Mark Lewandowski) heard about a hospice that was struggling with the high cost of prescription drugs. With already existing knowledge of the prescription medication industry, Paul and Mark put their expertise to good use and formed a new company (PDC). The service PDC provided then is just as simple as it is today. Our company helps hospices acquire medications from the pharmacy at a fair price while ensuring a high level of patient care through innovative palliative solutions. Needless to say, Mark and Paul fell in love with the hospice industry.

Today, our company is built on the virtues that Mark and Paul started back in 2001. We truly believe that being personal is the only way to do business in the hospice industry.


For more information, contact
Taylor Bradshaw at taylor@pdcrx.com
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www.PDCRx.com

Clinical Pearl…

Do We Still Need All
Of These Meds?!?
We have talked about the concept of polypharmacy before – taking multiple medications daily for the same symptoms and/or treatments. This is a particularly large issue in hospice due to both cost and the time consumption. Not only is it difficult for the caretakers to keep track of multiple medications and timelines, but as the patient in hospice progresses toward the end of life, they likely can no longer swallow pills and/or appropriately utilize inhalers. Therefore, for these reasons alone we should limit the medications and conduct thorough, and well educated, medication reviews upon admission to hospice as well as with any change in condition or cognition.

So…as we all know…this is easier said than done.

For patients with end-stage chronic illnesses, i.e. COPD, they have often been on the same regimen for years and therefore are not willing or open to changes in their current therapies…especially inhalers!

This is when we, as knowledgeable and confident hospice providers, need to step in to explain the pros and cons of multiple therapies.


Again, easier said than done.

Continue Reading…
Read Full Article
MEET OUR STAFF
Meet
Jaymie Wilson,
MSN, APRN-CNP, ACHPN

Clinical Account Manager
 
Jaymie, being a huge super nerd and school addict, completed her first degree in nutritional sciences from Oklahoma State University. After teaching for a bit, she went on to complete her BSN at The University of Tulsa where she then went on to work in critical care. After 8 years in the ICU, she was invited to join an inpatient palliative care team where she found her passion for advanced care planning, palliative care, symptom management and hospice education. She didn’t stop there! In 2015, she completed her advanced practice degree from The University of South Alabama and became an Adult-Gerontological Acute Care Nurse Practitioner. In June of 2017, Jaymie joined the PDC team as the Clinical Account Manager where she continues to work towards nursing education on end-of-life care. As the powerhouse she is, Jaymie is also the author and brains behind our blog!

Jaymie is truly a jack-of-all-trades. At work, she is a problem solver, leader, wealth of knowledge, and the epitome of patient care. In addition to being one of the fearless leaders of the PDC team, Jaymie is a dedicated mother and wife. She stays busy keeping up with her 2 daughters – Haylee (8) and Emma (2), as well as a 13 year old lab named Charlie, and her husband, Jason, of 13 years. (Jason proposed to Jaymie with their dog, Charlie!) When not in the office, Jaymie can be found boating at the lake, traveling, doing her best to be the “cool leader” in the youth group at her church, or attempting to be fit at the gym.

Jaymie is extremely passionate about sharing her knowledge through medical mission trips. In June of 2018, Jaymie went on the medical trip of a lifetime where she partook in a mission with Empower Tanzania (ETI). ETI works in partnership with rural communities and other organizations to facilitate activities that measurably and sustainably improve the lives of Tanzanians. She describes this trip as “incredibly eye-opening” and she is a proponent of everyone having this experience at least once in their life.

Jaymie embodies the values of a good leader, caring coworker, passionate nurse, dedicated mother & wife, youth group leader, and a mission trip warrior.

We are so lucky to have you on our team!
 
Just For Fun…

As the holiday fun sizzles out and 2019 begins, it is time to create new goals and new resolutions for the NEW year!

Here are a few of the New Year’s Resolutions had by PDCrx employees:
  • My resolution is to be able to say “no” to at least 75% of the sweets I see!
     
  • My resolution is to drink more whiskey and get a tattoo
     
  • Remember to brush my teeth at least once a day
     
  • My resolution is to drink more water each day and to finish a new book each month
     
  • Get FIT!
     
  • Drink more H20
     
  • Perform a random act of kindness once (or more) a month to a stranger
     
  • Sleep more
     
  • Utilize the YMCA membership
     
  • Practice being present
     
  • To be healthier in every way (mentally, physically, spiritually)

 
Where Will PDC Be This Month?
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Copyright © 2018, All rights reserved.

Our mailing address is:
Palliative Drug Care
130 N. Greenwood Ave.
Suite 200
Tulsa, OK 74120

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Do We Still Need All Of These Meds?!?

Do We Still Need All Of These Meds?!?

 

Do We Still Need All Of These Meds?!?

We have talked about the concept of polypharmacy before – taking multiple medications daily for the same symptoms and/or treatments. This is a particularly large issue in hospice due to both cost and the time consumption. Not only is it difficult for the caretakers to keep track of multiple medications and timelines, but as the patient in hospice progresses toward the end of life, they likely can no longer swallow pills and/or appropriately utilize inhalers. Therefore, for these reasons alone we should limit the medications and conduct thorough, and well educated, medication reviews upon admission to hospice as well as with any change in condition or cognition.

Again, easier said than done.

However, we need to explain everything thoroughly. Starting with acknowledging that the patient, and family members, may have hesitancy in changing or stopping certain medications. Listen to why they are hesitant. Often times it’s just because they are so used to those medications. You will also often hear something like “This is what has been working for him/her for so long.” This might be a good time to ask, “What do you mean by working?” Obviously, before asking such a bold question you need to be ensure you have built a rapport with the patient and family – which is achieved first by the listening. They need to know that their fears, concerns, goals, and hopes are all heard and respected.

 
shutterstock_183691856.jpg

Emphasize that this is a new phase or season of life. Medications that they had previously been prescribed were likely given to “cure” or prolong life, no matter the accompanying symptoms or adverse effects. With the transition to hospice comes the transition to palliative care – i.e. symptom management and quality of life, only! This is often a tough pill to swallow…pun intended.

So…as we all know…this is easier said than done.

For patients with end-stage chronic illnesses, i.e. COPD, they have often been on the same regimen for years and therefore are not willing or open to changes in their current therapies…especially inhalers! This is when we, as knowledgeable and confident hospice providers, need to step in to explain the pros and cons of multiple therapies.

It can also be extremely helpful to take the time to explain the pathophysiology of nearing the end of life. Particularly how the gut will slow and therefore become less effective at digesting pills – especially vitamins and unnecessary pills. Because of this, you increase the chance of nausea and other GI issues. Appetite naturally decreases at end of life, so do we really think it’s more important for the patient to fill up on pills and water, or better yet, crushed pills in nasty applesauce rather than eating and drinking the things that bring them joy? Absolutely not. That’s not fair and that’s not what hospice and palliative care are all about. 

LET THEM EAT CAKE! – insert overused Marie-Antoinette quote (so they say).

marie_antoinette_cake.gif
 
shutterstock_181476422.jpg

What’s the first thing we tend to do when a patient develops nausea? We add a med. But how about also taking a close look at what they are already on and possibly removing a med or 2…or 5? Interesting thought.

When it comes to specific medications that the patient refuses to give up, explain that the presented alternatives are of the same exact class and that it might be worth at least a week of trying the new medication. The alternatives can be more easily accessible to the patient and likely cost less money (primarily because hospice doesn’t need to be paying for the unnecessary medications and the patient would therefore be on the hook for paying out of pocket or through Part D). Additionally, if they are unwilling to stop a medication, offer the same deal – try stopping the medication for a week and see if they feel better/worse/same.

Nothing in hospice is permanent! This point needs to be stressed constantly. There can always be changes to medications, just as there will always be changes to how the patient feels. We must be willing to change and adapt with the patient and discuss these changes at length in IDG in order to come up with the most appropriate and fitting plan for the patient based on each team members’ interactions and experiences with the patient and his or her caretakers and family.

Be knowledgeable. Be confident. And always LISTEN.

Jaymie Wilson, APRN-CNP, ACHPN