Eli's Hospice Insider

Find out why and how to target inappropriate use of sedation.

"The use of chemical restraints is clearly a survey and compliance issue," says Beth Carpenter, president of Beth Carpenter and Associates in Lake Barrington, Ill.

So how can hospices walk that sometime fine line in deciding -- and demonstrating -- that a sedating medication is being used appropriately?

Evaluate the issue on a case-bycase basis in terms of how a medication affects the patient, advises attorney Rachel Hold-Weiss, an associate with Arent Fox in New York, N.Y.

And "any medication given to a hospice patient by hospice must be included in the plan of care," she says. "If the goal in giving Haldol, for example, is to make the patient more comfortable, easing restlessness, etc., the drug must be part of the plan of care," which includes thereason for giving the drug.

A big plus: "We have CMS saying that if a hospice is using Haldol for nausea or other symptoms related to the terminal illness...then it's absolutely appropriate to use the medication even though it's on the Beers list for [elderly patients]," says Judi Lund Person, with the National Hospice & Palliative Care Organization. (The Beers list identifies potentially inappropriate medications for elders.)

Keep the hospice patient as alert as possible if he has a goal of communicating with his family and having some quality of life in his last days, advises Thomas Snader, PharmD, a consultant in New Wales, Pa. "Look at the person's ADLs, quality of life, ability to dress and feed himself, and desire to interact with others and optimize that."

Documentation tip: The hospice team should also document its decision-making about using medications that cause sedation to the point that they affect ADLs and cognitive status, advises Snader.