AMERICANS HOME HEALTH AND HOSPICE Presented by: Tracey LeBlanc RN DCS HOSPICE AND PAIN AMERICANS HOME HEALTH AND HOSPICE Presented by: Tracey LeBlanc RN DCS

Goals By the end of this presentation, the audience will: Be able to spot indicators and benefits of hospice. Recognize the indicators and contra- indicators of opiate and other pain medications. Learn ways to store and dispose of medications. Identify ways to prevent diversion.

WHAT IS HOSPICE? Hospice is a medicare benefit that an individual may choose when they have a terminal disease and no longer wish to seek aggressive treatment. Hospice is usually covered by most insurances. And is considered a medicare benefit. With medicare there is no charge to the patient.

HOSPICE REQUIREMENTS In order to enroll in hospice a doctor must write and order that states the patient has a life expectancy of less than six months to live if the disease runs it’s normal course. Other criteria may be required with certain disease processes.

HOSPICE INDICATORS Having a terminal illness such as COPD, Heart Failure, Parkinson’s, CVA, and Alzheimer’s etc. These are just some of the Diagnosis. Other indicators include: weight loss, increased sleeping, current medications are no longer effective, un-controlled pain, wounds, etc.

WHAT DOES HOSPICE COVER? That varies from company to company. Americans Hospice covers the following: All medications related to comfort and the admitting diagnosis and comfort. All incontinent supplies. Nutritional supplements such as ensure or boost. All DME equipment such as hospital bed, oxygen etc.

SYMPTOM CONTROL Hospice specializes in controlling the symptoms associated with the end of life journey.

PAIN Pain is the number one symptom that needs to be addressed. There are many factors that attribute to pain medication being difficult to control and monitor.

PAIN MEDICATION OBSTACLES ADDICTION TOLERANCE THEFT DIVERSION DISPOSAL

OPIATES Opiates (morphine, oxycodone, fentanyl) Long acting and short acting. Contra indicators would be low respiratory rate and allergy. Indicators would be uncontrolled pain, and cachectic patients with fentanyl.

TOLERANCE and ADDICTION Long term use can lead to tolerance. Average doses now become less effective. More instances of breakthrough pain.

THEFT The Michigan Automated Prescription System (MAPS). Monitors patient schedule 2-5 controlled substances. Enables practitioners to determine if patients are receiving controlled substances from other providers and assist in the prevention of prescription drug abuse. Only authorized health professionals and law enforcement agencies have access to the database.

CALL THE POLICE If at any time drug diversion is suspected, follow company policy. This policy should include informing your supervisor of the suspicion. Call the police.

DIVERSION PREVENTION TACTICS Keep medications in a locked box and in their original packaging. Put these medications in a location not easily accessible to others. Track dosing. Ensure proper dosing.

DRUG DISPOSAL DO NOT FLUSH UNLESS LABEL SAYS ACCEPTABLE Dissolve meds in a small amount of hot water. Mix with an undesirable substance such as coffee grounds or kitty litter. Put in a container and seal with duct tape.

QUESTIONS? Call if you have any questions. Americans Hospice Care Tracey LeBlanc RN DCS 2575 N. McLeod Dr. Suite C. Saginaw MI 48604