Hospice care focuses on providing comfort and improving the quality of life for individuals with terminal illnesses. Managing pain, reducing discomfort, and controlling symptoms are essential parts of hospice care. Medications play a vital role in this process, but some drugs can pose risks. Therefore, proper identification and categorization of hazardous substances are crucial for safety. 

Since most hospice patients are elderly and receiving end-of-life care, ensuring their safety from the harmful effects of toxic substances is essential. Besides protecting patients, safety protocols also help safeguard hospice workers while ensuring compliance with regulatory standards for a safe care environment. 

Identifying potential hazards begins with listing the medications commonly used in hospice care. Creating a comprehensive list helps recognize risks, making it easier to plan for emergencies and implement effective safety measures. 

In this blog, we’ll explore commonly prescribed hospice medications, their purposes, and the safety risks they may present. We’ll also cover important safety considerations to help ensure a secure environment for both patients and caregivers. 

 

Understanding Hospice Medications 

Surveys show that the three most common conditions leading to hospice admission are cancer, dementia, and lung disease. Hospice medications focus on providing comfort and preserving the patient’s dignity during the final stages of life, rather than treating the underlying illness. While there are hundreds of medications used in hospice care, six of the most administered include acetaminophen, morphine, haloperidol, lorazepam, prochlorperazine, and atropine. These medications are widely used due to their effectiveness in managing pain, anxiety, and other distressing symptoms. 

 

Common Categories of Hospice Medications 

 

Before we discuss the names, it’s better to introduce the drugs in categories. Here’s what you need to know:  

  1. Pain Relievers (Analgesics)

  • Purpose: To manage moderate to severe pain. 
  • Examples: Morphine, Oxycodone, Hydromorphone, Fentanyl. 
  • Usage: Often administered orally, intravenously, or via patches for continuous pain relief. 

 

  1. Anti-Anxiety Medications (Anxiolytics)

  • Purpose: To reduce anxiety and promote calmness. 
  • Examples: Lorazepam (Ativan), Diazepam (Valium), Alprazolam (Xanax). 
  • Usage: Helps manage agitation and distress. 

 

  1. Anti-Nausea Medications (Antiemetics)

  • Purpose: To control nausea and vomiting. 
  • Examples: Ondansetron (Zofran), Metoclopramide (Reglan), Promethazine (Phenergan). 
  • Usage: Often used for patients experiencing nausea from medications or illness. 

 

  1. Respiratory Medications

  • Purpose: To ease breathing difficulties. 
  • Examples: Morphine (for breathlessness), Albuterol, Ipratropium. 
  • Usage: Used for conditions like COPD and end-stage lung diseases. 

 

  1. Anticholinergics

  • Purpose: To reduce excessive secretions and prevent the death rattle. 
  • Examples: Atropine Drops, Scopolamine Patches. 
  • Usage: Administered as drops or patches to reduce saliva and mucus production. 

 

  1. Laxatives and Stool Softeners

  • Purpose: To prevent constipation caused by pain medications. 
  • Examples: Docusate Sodium (Colace), Senna, Bisacodyl. 
  • Usage: Often given alongside opioids to avoid discomfort from constipation. 

 

  1. Antipsychotics

  • Purpose: To manage agitation, hallucinations, or delirium. 
  • Examples: Haloperidol, Quetiapine, Risperidone. 
  • Usage: Used in cases of severe agitation or confusion. 

 

Essential Medicines in Hospice Care 

When it comes to hospice care, having the right medications on hand is crucial for providing comfort and managing symptoms effectively. Below is a list of commonly used medicines in hospice settings, categorized to address various needs such as pain relief, anxiety, and symptom control. 

 

 

  1. Acetaminophen

  • Purpose: Used as a pain reliever and fever reducer. Commonly administered for mild to moderate pain relief in hospice care. 
  • Hazardous: Generally not classified as hazardous but can cause liver damage with excessive use or accidental overdose. 

 

  1. Carbamazepine

  • Purpose: Primarily used as an anticonvulsant to manage seizures and nerve pain. It can also be prescribed for mood stabilization. 
  • Hazardous: Yes, it is considered hazardous due to the potential for serious skin reactions, liver toxicity, and bone marrow suppression with prolonged use. 

 

  1. Morphine

  • Purpose: A strong opioid analgesic used for managing severe pain and shortness of breath in terminally ill patients. 
  • Hazardous: Yes, it is classified as hazardous due to its potential for respiratory depression, dependency, and overdose risks. 

 

  1. Haloperidol

  • Purpose: An antipsychotic often used to manage agitation, delirium, and nausea in hospice patients. 
  • Hazardous: Yes, it is considered hazardous due to risks of severe side effects such as heart rhythm issues, neurotoxicity, and extrapyramidal symptoms. 

 

  1. Lorazepam (Ativan)

  • Purpose: A benzodiazepine used for anxiety relief, sedation, and management of seizures in palliative care. 
  • Hazardous: Yes, it is hazardous as it can cause respiratory depression, dependency, and sedation risks. 

 

  1. Prochlorperazine

  • Purpose: An antiemetic (anti-nausea) and antipsychotic medication commonly used to manage nausea, vomiting, and agitation. 
  • Hazardous: Yes, it is hazardous due to its potential to cause sedation, dizziness, and neurotoxicity with prolonged use. 

 

  1. Atropine

  • Purpose: Used to reduce excessive respiratory secretions, often in end-of-life care to manage “death rattle.” 
  • Hazardous: Generally not considered hazardous in small doses but can be toxic in large amounts, leading to dry mouth, blurred vision, and increased heart rate. 

 

  1. Dexamethasone

  • Purpose: A corticosteroid used for reducing inflammation, managing severe pain, and treating nausea or brain swelling. 
  • Hazardous: Yes, it can be hazardous due to potential side effects like immunosuppression, hyperglycemia, and mood changes. 

 

  1. Trazodone

  • Purpose: An antidepressant commonly used for managing depression, anxiety, and insomnia in hospice care. 
  • Hazardous: Generally not classified as hazardous, but it can cause dizziness, sedation, and rare cases of serotonin syndrome. 

 

Chemical Safety Management Considerations in Hospice Medication 

Ensuring the safe handling, storage, and administration of medications in a hospice setting is critical. It helps protect both patients and caregivers. With a wide variety of medications in use—ranging from controlled substances to potentially hazardous chemicals—proper management is essential. Here are key considerations for chemical safety in hospice medication: 

 

Proper Storage 

  • Store medications in secure, designated areas with appropriate temperature and humidity controls. 
  • Clearly label all medicines to prevent confusion and ensure compliance with legal regulations. 

 

Safe Handling Procedures 

  • Train staff and caregivers on safe handling practices to minimize exposure to hazardous substances. 
  • Use gloves, masks, or other protective equipment when handling certain medications, such as chemotherapy agents or opioids. 

 

Disposal of Medications 

  • Follow proper disposal methods to prevent misuse or environmental contamination. 
  • Adhere to local and national guidelines for the disposal of controlled substances and hazardous materials. 

 

Monitoring and Documentation 

  • Maintain accurate records of medication usage, storage, and disposal. 
  • Regular audits help ensure compliance with safety standards and identify areas for improvement. 

 

Emergency Preparedness 

  • Have protocols in place for handling accidental exposure, spills, or adverse reactions. 
  • Ensure easy access to Material Safety Data Sheets (MSDS) for all medications. 

 

Compliance with Regulations 

  • Stay updated on healthcare and safety regulations governing hospice medications. 
  • Regularly train staff in the latest requirements to ensure ongoing compliance. 

 

Conclusion 

Hospice medications are essential in providing comfort during end-of-life care, but ensuring the safety of both patients and caregivers is equally important. A well-structured chemical safety management system, combined with thoughtful planning, creates a secure environment where high-quality patient care can be delivered while protecting healthcare professionals and patients alike.