February 2019 - Treating dyspnea improves function in late stage COPD and CHF. Consider using a low-dose opioid 30 – 60 minutes before planned exertion to improve activity tolerance. Patients with palliative goals are excluded from opioid prescribing...
January 2019 - That pit in your stomach means you need to talk to a team member or colleague about a patient’s care. Moral distress occurs when you think you know the right thing to do, but you feel constrained from doing it. It is an important contributor to burnout...
December 2018 - Many dying patients are unable to ask for comfort medicines. More patients are dying in senior facilities without 24-hour staff able to assess nonverbal pain and dyspnea or use “as needed” medications. We find scheduling low-dose, short-acting opioids...
November 2018 -There is a big difference between AICD deactivation and pacemaker deactivation. More patients (or their surrogates) are requesting the deactivation of cardiac devices at end of life. Some want a more natural death. Others hope for an easier or earlier...
October 2018 - Double-booked patients, charts, emails, curbsides, phone calls, meetings. . . Work late and start again the next day. It is important to find a way to rest in the middle of things. Stopping, even briefly, allows us to step out of our suffering and see...
September 2018 - A picture speaks a thousand words. (see above) All hospice is palliative care; not all palliative care is end-of-life or hospice care. For more information contact Dr. Leslie Estep or Dr. Anita Meyer at Hospice of the Northwest, 360-814-5550, or...
August 2018 - Providing serious medical information is challenging. Below are helpful steps and phases. 1. Use simple language. “I wish I had better news, but the biopsy showed cancer.” “I’m afraid you have had a miscarriage.” 2. Listen, use silence, and acknowledge...
July 2018 - De-escalating supplements can improve quality of life. Patients referred to hospice are often on multiple supplements. They are relieved when some pills can be stopped. Consider discontinuing the following supplements in your palliative patients: Calcium...
June 2018 - Falls are the number one cause of death from injury in patients over 65. A simple fall risk screen for elders developed by the CDC includes the following three questions: 1. Have you fallen in the past year? 2. Do you feel unsteady when standing or...
May 2018 - Make a recommendation. You can reduce your patient’s and family’s distress by making a recommendation about CPR based on what you know about CPR as a medical procedure. “Do everything, doctor!” may not mean full code. Patients may be expressing fear; they...
