Also Known As:
Hospice medications, symptom medications, comfort medications, the hospice comfort kit
Type:
Symptom-management pharmaceutical care
Primary Purpose:
To control pain, breathlessness, nausea, anxiety, agitation, and other symptoms so the patient remains comfortable.
When It Applies:
Throughout the hospice stay. The medication list is adjusted constantly as symptoms change.
Who Is Involved:
The hospice physician and medical director who approve the medication plan, the RN case manager who adjusts and administers, and the family who often gives doses between visits.
Where It Occurs:
Delivered to the patient’s home or facility, kept secured in the patient’s room, and titrated based on response.
Duration:
For as long as the medication is needed. New medications are added and old ones discontinued as symptoms shift.
Coverage:
Medications related to the terminal diagnosis and symptom management are 100% covered by the Medicare Hospice Benefit.
Key Focus:
Pain management, breathing support, anxiety and agitation control, nausea, constipation, sleep, and skin care.
Common Misunderstanding:
Hospice medications are not about sedation. The goal is comfort with as much alertness as the patient wants, which often means active titration to find the lowest dose that controls symptoms.
What’s in a Typical Hospice Medication Plan
Every hospice patient’s plan is different, but most include some combination of:
- Pain, morphine, hydromorphone, methadone, or other opioids titrated to comfort
- Breathlessness, low-dose opioids, lorazepam, oxygen
- Anxiety, lorazepam, alprazolam, or other anxiolytics
- Nausea, ondansetron, haloperidol, prochlorperazine
- Constipation, senna, polyethylene glycol, lactulose
- Agitation (especially in dementia), haloperidol, low-dose antipsychotics, environmental measures
- Excessive secretions, glycopyrrolate, atropine drops
- Sleep, trazodone, melatonin, mirtazapine
The Hospice Comfort Kit
Lifted nurses bring an emergency comfort kit to the home at admission. The kit contains a few days’ worth of as-needed medications for the most common symptom crises, pain, breathlessness, nausea, anxiety. The family is taught what each medication is for and when to give it.
The kit means a 2 a.m. symptom crisis doesn’t require waiting for a pharmacy delivery. The nurse can guide the family by phone or come to the home, and the medications are already there.
Adjusting Medications as Things Change
Hospice medications are not set-and-forget. The RN case manager evaluates symptoms at every visit and adjusts doses, frequency, and routes (oral, sublingual, transdermal, suppository) based on how the patient responds. Active dying often requires very different medication plans than stable hospice care.
If you have questions about a medication on your loved one’s plan, ask the nurse at any visit, or call the 24/7 line. Contact us with any concerns.