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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1084 — A Hospice Emergency Kit (HEK): Evaluation of Effectiveness by Retrospective Chart Review and Hospice Nurse Questionnaires

Bailey FALeigh AWilliams BR, and Burgio KL, Birmingham VA Medical Center and University of Alabama at Birmingham;

Patients in home hospice often develop pain, dyspnea, delirium, and other symptoms as they near end of life. Hospice Emergency Kits (HEKs) contain medications intended to enable rapid relief of emergent symptoms during the dying process. The purpose of this pilot study was to describe the current use of HEKs at a VA Medical Center and assess nurses’ perceptions of its effectiveness, safety, and timeliness for relieving symptoms at end of life.

We performed retrospective chart reviews of deceased Veterans from the Birmingham VAMC who had been discharged to hospice in 2009. In addition, anonymous questionnaires were distributed to nurses at sixteen community hospices providing care for VA patients.

HEKs were distributed to 68 (89%) patients referred to home hospice. Use of the HEK was documented in 50% (N = 34). Documentation was found for the use of: morphine concentrate (N = 25), antibiotic (N = 12), haloperidol (N = 10), furosemide (N = 7), lorazepam (N = 5), and scopalamine patch (N = 4). In 22%, documentation suggested that the HEK facilitated death at home (versus hospital). In one case, there was concern of inappropriate use of medications. Questionnaires were returned by 78 hospice nurses (49%). Nurses estimated that, when available, HEKs were used 65% of the time. Fifty-five percent of nurses felt HEKs were helpful 100% of the time; 79% reported they were helpful at least 70% of the time. Most (86%) believed HEKs reduced caregiver/patient anxiety. Symptoms reported as most commonly addressed were agitation, shortness of breath, pain, and secretions.

HEKs appear to be a safe and effective method of improving symptom relief in the management of home hospice patients. More research is needed to define the ideal HEK, test its effectiveness, and improve implementation.

If determined to be effective, the HEK may improve our ability to safely support Veterans' hospice care and death in the home when this is the preference of the Veteran and family caregiver. By empowering Veterans, families, and nurses with a HEK in the home, Veterans could have improved symptom control, families could have improved self-efficacy as caregivers, and costs may be reduced by avoiding visits to emergency departments and hospital admission.

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