Cholinesterase Inhibitor Use in Patients With Dementia Admitted to a Palliative Care Unit

2021 ◽  
pp. 104990912098511
Author(s):  
Giulia-Anna Perri ◽  
Jessica Wilson ◽  
Sandra Gardner ◽  
Anna Berall ◽  
Anne Kirstein ◽  
...  
Keyword(s):  
Palliative Care ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Palliative Care Unit ◽  
Dose Frequency ◽  
Severe Dementia ◽  
Comorbid Diagnosis ◽  
Diagnosis Of Dementia ◽  
Future Work ◽  
Current Guidelines

Objectives: Current guidelines suggest that patients with severe dementia on cholinesterase inhibitors (CHEIs) should discontinue their CHEIs by taper. This study aims to define the prevalence of patients admitted to a palliative care unit (PCU) with dementia on a CHEI and to determine whether these patients were tapered off their CHEIs according to current deprescribing guidelines. Design: This is a descriptive retrospective chart review that examined patients admitted to a PCU with dementia on a CHEI from January 2015 to June 2019. Methods: Individuals admitted to the PCU with a primary or comorbid diagnosis of dementia were identified. Their corresponding CHEI dose, frequency and discontinuation pattern were identified. Data were analyzed using descriptive statistics. Results: A total of 36 patients were admitted to the PCU with dementia on a CHEI (prevalence of 2.3%). The median length of stay was 21 days. For 31 of these patients, their CHEI was discontinued, only 9 of which had a taper. Of the 24 patients who discontinued their CHEI suddenly, 10 patients had an order to discontinue their CHEI in the last 2 days before their date of death. Conclusion: This study suggests that although patients admitted to a PCU with dementia have their CHEI discontinued, the discontinuation was done without a taper. In many cases the CHEIs were continued through the active stage of dying. Future work should explore reasons why PCU physicians are mostly late to taper CHEIs for patients admitted with dementia.

A Retrospective Chart Review of Transfusion Practices in the Palliative Care Unit Setting

2018 ◽  
Vol 36 (3) ◽  
pp. 185-190 ◽  
Author(s):  
Giovanna Sirianni ◽  
Giulia Perri ◽  
Jeannie Callum ◽  
Sandra Gardner ◽  
Anna Berall ◽  
...  
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Chart Review ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Palliative Care Unit ◽  
Assessment Tools ◽  
Palliative Care Units

Background: There remains limited data in the literature on the frequency, clinical utility and effectiveness of transfusions in palliative care, with no randomized controlled trials or clinical practice guidelines on this topic. There are no routinely accepted practices in place for the appropriate transfusion of blood products in this setting. Aim: The aim of this study was to retrospectively review all transfusions in the palliative care units of 2, tertiary care hospitals in Canada. The goals were to elucidate the frequency, indications, patient characteristics, and practices around this intervention. Design: Descriptive, retrospective chart review. Setting/Participants: The clinical charts of patients admitted to the palliative care unit and who obtained blood transfusions for the period of April 1, 2015, to March 31, 2017, were reviewed. All patients admitted who obtained a transfusion were included. There were no exclusion criteria. Results: Transfusions in the palliative care units were rare despite their availability (0.9% at Sunnybrook and 1.4% Baycrest) and were primarily given to patients with cancer. The main symptom issues identified for transfusion were fatigue and dyspnea. The majority of patients endorsed symptomatic benefit with minimal adverse reactions though pre- and post-transfusion assessment practices varied greatly between institutions. Conclusions: Transfusions in the palliative care units were infrequent, symptom targeted, and well tolerated, though the lack of standardized pre/post assessment tools limits any ability to draw conclusions about utility. Patients would benefit from additional research in this area and the development of clinical practice guidelines for transfusions in palliative care.

scholarly journals Off-label use in Palliative Care – more common than expected. A retrospective chart review

2021 ◽  
Author(s):  
Vera Hagemann ◽  
Claudia Bausewein ◽  
Constanze Rémi
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Drug Use ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Palliative Care Unit ◽  
List Type ◽  
Off Label Use ◽  
Off Label ◽  
Label Use

AbstractObjectiveOff-label drug use seems to be integral to palliative care pharmacotherapy. Balancing potential risks and benefits in the context of limited therapeutic options is challenging. To provide specific support for clinicians in dealing with off-label use, it is essential to understand off-label use in everyday clinical practice.The aim of this pilot study was to quantify and describe off-label use in a palliative care unit.MethodsRetrospective chart review of all adult patients treated on a palliative care unit in 10/2017. All data on drug use e.g. indication, dose, route of administration were extracted and matched with the prescribing information. Identified off-label use was subsequently compared with recommendations in the relevant literature. The main outcome measure was frequency and type of off-label drug use.Results2,352 drug application days (d) and 93 drugs were identified for 28 patients. Of all drugs, 47 (51%) were used off-label at least once. Most off-label uses concerned indication (57%), followed by mode of administration. In drugs highly relevant to palliative care the rate of off-label use was as high as 67%. The extent to which off-label therapy was supported by literature was very variable and ranged from 0 to 88%.ConclusionsThis single-unit data confirms the high prevalence of off-label use in palliative medicine and demonstrates that off-label use in palliative care is very multifaceted. The data presented allows for a more precise characterization of various aspects of off-label use in order to derive concrete further measures for research and clinical practice.What is already known on this subjectOff-label drug use is likely to be common in palliative care, but detailed data is very limitedOff-label drug use is a potential threat for patient safetyPhysicians state to make therapeutic decisions based on their own experience, due to a lack of available evidence and lack of support in assessmentWhat this study addsoff-label use in palliative care is multifacetedthe mode of administration (e.g. combination with other drugs in a syringe driver) is beside indication a common reasons for off label usethe proportion of off-label use without sound evidence is high.

Harnessing the Chaplain’s Capacity to Identify Unmet Palliative Needs of Vulnerable Older Adults in the Emergency Department

2021 ◽  
pp. 082585972110033
Author(s):  
Elizabeth Hamill Howard ◽  
Rachel Schwartz ◽  
Bruce Feldstein ◽  
Marita Grudzen ◽  
Lori Klein ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
End Of Life Care ◽  
Older Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Life Care ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
One Year

Objective: To explore chaplains’ ability to identify unmet palliative care (PC) needs in older emergency department (ED) patients. Methods: A palliative chaplain-fellow conducted a retrospective chart review evaluating 580 ED patients, age ≥80 using the Palliative Care and Rapid Emergency Screening (P-CaRES) tool. An emergency medicine physician and chaplain-fellow screened 10% of these charts to provide a clinical assessment. One year post-study, charts were re-examined to identify which patients received PC consultation (PCC) or died, providing an objective metric for comparing predicted needs with services received. Results: Within one year of ED presentation, 31% of the patient sub-sample received PCC; 17% died. Forty percent of deceased patients did not receive PCC. Of this 40%, chaplain screening for P-CaRES eligibility correctly identified 75% of the deceased as needing PCC. Conclusion: Establishing chaplain-led PC screenings as standard practice in the ED setting may improve end-of-life care for older patients.

Extended-hours palliative care service with a hospital-avoidance and enhanced-care approach: report of a quality improvement project

2020 ◽  
Vol 26 (5) ◽  
pp. 222-228
Author(s):  
Robyn Keall ◽  
Melanie Lovell
Keyword(s):  
Palliative Care ◽  
Usual Care ◽  
Chart Review ◽  
Care Service ◽  
Palliative Care Service ◽  
Retrospective Chart Review ◽  
Improvement Project ◽  
Acute Hospitalisation ◽  
Care Approach ◽  
After Hours

Background: A community palliative care service (CPCS) identified its after-hours support as sub-optimal in avoiding acute hospitalisation and supporting patients to remain at home. It created and conducted a pilot of an extended hours palliative care service (EHPCS) using current resources. Aims: To evaluate the efficacy of an extended hours palliative care service pilot. Methods: Retrospective chart review of after-hours calls taken before the trial, usual care, was undertaken. During the trial, quantitative data was gathered of the outcome of each after-hours call, including outcomes of occasion of service, reason for and length and times of calls. Findings: The extended hours palliative care service, compared with usual care, showed an almost 50% decrease in acute hospitalisation, nearly doubled after-hours palliative care unit admission and a 17% increase in patients staying in their home. EHPCS was positively received by CPCS staff, despite cost and workforce impact. Conclusions: EHPCS can positively impact on reducing avoidable hospitalisations and facilitate palliative care patients to be in their preferred place of care.

Prevalence, incidence and associated factors of pressure ulcers in home palliative care patients: A retrospective chart review

2017 ◽  
Vol 32 (1) ◽  
pp. 299-307 ◽  
Author(s):  
Marco Artico ◽  
Angelo Dante ◽  
Daniela D’Angelo ◽  
Luciano Lamarca ◽  
Chiara Mastroianni ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Palliative Care ◽  
Pressure Ulcer ◽  
Associated Factors ◽  
Chart Review ◽  
Pressure Ulcers ◽  
Terminally Ill ◽  
Retrospective Chart Review ◽  
Karnofsky Performance Scale ◽  
Performance Scale

Background: Terminally ill patients are at high risk of pressure ulcers, which have a negative impact on quality of life. Data about pressure ulcers’ prevalence, incidence and associated factors are largely insufficient. Aim: To document the point prevalence at admission and the cumulative incidence of pressure ulcers in terminally ill patients admitted to an Italian home palliative care unit, and to analyse the patients’ and caregivers’ characteristics associated with their occurrence. Design: Retrospective chart review. Setting/participants: Patients ( n = 574) with a life expectancy ⩽6 months admitted to a palliative home care service were included in this study. Results: The prevalence and incidence rates were 13.1% and 13.0%, respectively. The logistic regression models showed body mass index ( p < 0.001), Braden score at risk ( p < 0.001), Karnofsky Performance Scale index <30 ( p < 0.001), patients’ female gender, patients’ age >70 and >1 caregiver at home as the dichotomous variables predictors of presenting with a pressure ulcer at time of admission and during home palliative care. Conclusion: The notable pressure ulcers’ incidence and prevalence rates suggest the need to include this issue among the main outcomes to pursue during home palliative care. The accuracy of body mass index, Braden Scale and Karnofsky Performance Scale in predicting the pressure ulcers risk is confirmed. Therefore, they appear as essential tools, in combination with nurses’ clinical judgment, for a structured approach to pressure ulcers prevention. Further research is needed to explore the home caregivers’ characteristics and attitudes associated with the occurrence of pressure ulcers and the relations between their strategies for pressure ulcer prevention and gender-related patient’s needs.

scholarly journals The Effect of Rapid Response Teams on End-of-Life Care: A Retrospective Chart Review

2014 ◽  
Vol 21 (5) ◽  
pp. 302-306 ◽  
Author(s):  
Benjamin Tam ◽  
Mary Salib ◽  
Alison Fox-Robichaud
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Rapid Response ◽  
Rapid Response Teams ◽  
Term Care ◽  
Palliative Care Services ◽  
Eol Care ◽  
The Impact

BACKGROUND: A subset of critically ill patients have end-of-life (EOL) goals that are unclear. Rapid response teams (RRTs) may aid in the identification of these patients and the delivery of their EOL care.OBJECTIVES: To characterize the impact of RRT discussion on EOL care, and to examine how a preprinted order (PPO) set for EOL care influenced EOL discussions and outcomes.METHODS: A single-centre retrospective chart review of all RRT calls (January 2009 to December 2010) was performed. The effect of RRT EOL discussions and the effect of a hospital-wide PPO set on EOL care was examined. Charts were from the Ontario Ministry of Health and Long-Term Care Critical Care Information Systemic database, and were interrogated by two reviewers.RESULTS: In patients whose EOL status changed following RRT EOL discussion, there were fewer intensive care unit (ICU) transfers (8.4% versus 17%; P<0.001), decreased ICU length of stay (5.8 days versus 20 days; P=0.08), increased palliative care consultations (34% versus 5.3%; P<0.001) and an increased proportion who died within 24 h of consultation (25% versus 8.3%; P<0.001). More patients experienced a change in EOL status following the introduction of an EOL PPO, from 20% (before) to 31% (after) (P<0.05).CONCLUSIONS: A change in EOL status following RRT-led EOL discussion was associated with reduced ICU transfers and enhanced access to palliative care services. Further study is required to identify and deconstruct barriers impairing timely and appropriate EOL discussions.

scholarly journals INVESTIGATING THE PHOTOTHERAPY THRESHOLDS IN PRETERM INFANTS

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e28-e28 ◽  
Author(s):  
Thivia Jegathesan ◽  
Michael Sgro ◽  
Vibhuti Shah ◽  
Aidan Campbell ◽  
Douglas Campbell
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Chart Review ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Term Infants ◽  
Treatment Thresholds ◽  
Weight Outcomes ◽  
The Mean ◽  
Current Guidelines

Abstract BACKGROUND Currently there are limited guidelines for the management of hyperbilirubinemia in preterm infants. Current guidelines are limited to individual sites and are consensus-based opinions. The current decrease in chronic bilirubin encephalopathy in preterm infants is a result of liberal use of phototherapy that are not based on evidence from a large dataset of preterm infants. The pattern of bilirubin levels in preterm is unclear and currently based on clinical judgement. Nomograms in term infants has been proven to be beneficial and effective in reducing unnecessary treatment of hyperbilirubinemia. A nomogram designed for preterm infants would allow health professionals to quantify risk based on evidence based methods and reduce the number of test done on preterm infants. OBJECTIVES The objectives of this study are 1) To determine photherapy thresholds in preterm infants and 2) To determine the normative pattern of bilirubin values in preterm infants. DESIGN/METHODS A multi-site retrospective chart review of preterm infants ≤ 35 weeks gestation born between January 2012- November 2017 was conducted. The following data was collected; all TSB, postnatal hours of age, duration of phototherapy, infant characteristics (gestational age, birth weight, outcomes) and maternal history (inter and anter partum medication). TSB samples prior to the initiation of phototherapy were analyzed per hour and stratified by gestational age groups. RESULTS A total of 330 preterm infants were included in the retrospective review (50 24-28 weeks gestation, 100 29-32 weeks gestation, and 180 33–35 weeks gestation). The mean peak bilirubin in infants 33-35 week gestation was 198 umol/L at 4 days. These infants were started on phototherapy at a mean age of 89 hours. At 24 hours of age these infants’ bilirubin was 104 umol/L (72-189umol/L). The mean peak bilirubin in infants 29–32 weeks gestation was 181umol/L at 5 days. At 24 hours of age the mean bilirubin was 109 umol/L. Finally in infants 24–28 weeks gestation the mean peak bilirubin was 127 umol/L at 4 days. These infants were started on phototherapy at 44 hours of age. CONCLUSION Bilirubin values in preterm infants is hetergenous across gestional ages. Phototherapy treatment thresholds are lower in preterm infants between 24–28 weeks gestation. A nomogram for preterm infants maybe possible in infants between 29–35 weeks. Further research is required to determine hour specific bilirubin levels in preterm infants.

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