April 2018 - A patient’s past experience with CPR or intensive care is important. Before trying to complete a POLST, learn about your patient’s experience. Personal experience is more important to many patients than statistics. To find out what they’re thinking, try...
Palliative Pearls
The CPR Discussion – Part I
March 2018 - Use facts not fear to help your patients make a CPR decision. - CPR on TV looks easy and seems to be very successful; unfortunately, in real life, only 1 in 8 patients survive witnessed arrest. Many of the survivors have a reduced functional capacity...
Comfort Medications Toolkit
February 2018 - For patients unable or unwilling to come onto hospice quickly, here is a basic toolkit of medications for typical end-of-life symptoms. Even patients who can no longer swallow can use concentrated sublingual medications. We generally provide an...
“Good Enough” Prognostication
January 2018 - The point of prognostication is not to be right, but to help people prepare. Avoid the trap of exact numbers. Develop a prognosis that is good enough to allow for important decisions to be made around advanced planning, therapeutic interventions, and...
Anticoagulation in Frail Patients
December 2017 - The risk of intracranial or GI hemorrhage in a debilitated ambulatory patient at risk for falling likely exceeds the benefit of stroke reduction.* Most experts agree that anticoagulation should not be used in these cases - Patient has a high risk of...
Your Patients Need Your Help
October 2017 - "VitalTalk Tips" – A free app to help you with difficult conversations. VitalTalk Tips is free and easy to use. Its layered structure allows you to use it to quickly review a topic before a difficult conversation or to study in greater depth. It sends a...
Words Can Heal
October 2017 - VitalTalk Tips – A free app to help you with difficult conversations. VitalTalk Tips is free and easy to use. Its layered structure allows you to use it to quickly review a topic before a difficult conversation or to study in greater depth. It sends a...
Use Senna as First Line for Opiate Induced Constipation at End-of-Life
September 2017 - Opiates cause constipation by several mechanisms: - Binding intestinal mu receptors and slowing peristalsis - Delaying gastric emptying - Increasing anal sphincter tone - Increasing water and electrolyte reabsorption from slowed peristalsis. Our...
Who Will Decide if You Can’t?
August 2017 - Establishing Durable Power of Attorney for Healthcare (DPOA-HC) is a gentle way to start advance care planning. In the state of Washington, if no DPOA-HC has been established, the responsibility for medical decision making for an incapacitated adult...
Taper BP Meds for Falling, Frail Elders
July 2017 - Study shows burden may outweigh the benefit for managing hypertension in elders with a history of falls. Antihypertensive medications were associated with an increased risk of a serious fall injury, particularly among those with previous falls. The...