Hospices that provide care at home struggle to prevent the diversion or misuse of drugs critical to end-of-life care, but some key practices can make the process easier.
Patient education and communication are critical, experts say, especially at the time of admission. Some states, including Delaware, mandate that hospices educate patients and their caregivers about drug disposal policies and procedures when patients are admitted. Hospices often include this information in orientation materials and have their admission staffers review the policies and practices with their patients and caretakers.
“It’s very important that the family understand that we’ll be disposing of the drugs at the end of care and how that works,” said Judi Lund Person, vice president of regulatory and compliance for the National Hospice and Palliative Care Organization.
Open dialogue sets expectations and illuminates the risk of diversion or misuse. Opioid treatment agreements, which may include informed consent documentation, allow patients and providers to discuss the risks and benefits of using opioids to manage pain and to develop a care plan. Providers can use these discussions to help screen and plan for possible drug diversion or misuse.
Kentucky-based Bluegrass Care Navigators uses the Opioid Risk Tool—a self-reported, proven screening tool—to vet all patients who receive controlled substances. If patients or their families are at risk, the organization will carry out a care plan to address substance abuse and diversion.
It’s essential to treat every patient and family equally to ensure that they don’t feel like hospice staff are targeting, policing or accusing them, said Dr. Salli Whisman, senior hospice medical director for Bluegrass Care Navigators.
Hospices should communicate that “safe medication practice is, ‘Just what we do for all our patients,’ ” she said.
If a hospice suspects a patient’s medications are likely to fall into the wrong hands, they can limit and document the number of drugs in the patient’s home.
For instance, “If drug diversion or medication issues are suspected, three-day supplies of medications are delivered in bubble packs and counted at each visit,” said Rebecca Gatian, chief clinical officer for Florida-based Avow Hospice.