Frequency and Documentation of Medication Decisions on Discharge from the Hospital to Hospice Care

Kirsten L. Kadoyama, Brie N. Noble, Shigeko Izumi, Erik Fromme, Jennifer Tjia, Mary Lynn McPherson, Carey B. Candrian, Jessina C. McGregor, In Young Ku, Jon P. Furuno

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To quantify the frequency and type of medication decisions on discharge from the hospital to hospice care. DESIGN: Retrospective cohort study. SETTING: A 544-bed academic tertiary care hospital in Portland, Oregon. PARTICIPANTS: A total of 348 adult patients (age ≥18 y) discharged to hospice care between January 1, 2010, and December 31, 2016. MEASUREMENTS: Data were collected from an electronic repository of medical record data and a manual review of patients’ discharge summaries. Our outcomes of interest were the frequency and type of medication decisions documented in patients’ discharge summaries. Medication decisions were categorized as continuation, continuation but with changes in dose, route of administration, and/or frequency, discontinuation, and initiation of new medications. We also collected data on the frequency of patient/family in the participation of medication-related decisions. RESULTS: Patients were prescribed a mean of 7.1 medications (standard deviation [SD] = 4.8) on discharge to hospice care. The most prevalent medications prescribed on discharge were strong opioids (82.5%), anxiolytics/sedatives (62.9%), laxatives (57.5%), antiemetics (54.3%), and nonopioid analgesics (45.4%). However, only 67.8% (213/341) of patients who were prescribed an opioid on discharge to hospice care were also prescribed a laxative. Discharging providers made a mean of 15.0 decisions (SD = 7.2) per patient of which 28.5% were to continue medications without changes, 6.7% were to continue medications with changes, 30.3% were to initiate new medications, and 34.5% were to discontinue existing medications. Patients and/or family members were involved in medication decisions during 21.6% of discharges; patients were involved in 15.2% of decisions. CONCLUSION: Patients averaged more than 15 medication decisions on discharge to hospice care. However, it was rarely documented that patients and/or their families participated in these decisions. J Am Geriatr Soc, 2019.

Original languageEnglish (US)
JournalJournal of the American Geriatrics Society
DOIs
StatePublished - Jan 1 2019

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Hospice Care
Documentation
Patient Discharge Summaries
Laxatives
Opioid Analgesics
Non-Narcotic Analgesics
Antiemetics
Electronic Health Records
Anti-Anxiety Agents
Tertiary Healthcare
Hypnotics and Sedatives
Tertiary Care Centers
Cohort Studies
Retrospective Studies

Keywords

  • discharge planning
  • hospice care
  • medication decisions
  • transition to hospice

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Frequency and Documentation of Medication Decisions on Discharge from the Hospital to Hospice Care. / Kadoyama, Kirsten L.; Noble, Brie N.; Izumi, Shigeko; Fromme, Erik; Tjia, Jennifer; McPherson, Mary Lynn; Candrian, Carey B.; McGregor, Jessina C.; Ku, In Young; Furuno, Jon P.

In: Journal of the American Geriatrics Society, 01.01.2019.

Research output: Contribution to journalArticle

Kadoyama, Kirsten L. ; Noble, Brie N. ; Izumi, Shigeko ; Fromme, Erik ; Tjia, Jennifer ; McPherson, Mary Lynn ; Candrian, Carey B. ; McGregor, Jessina C. ; Ku, In Young ; Furuno, Jon P. / Frequency and Documentation of Medication Decisions on Discharge from the Hospital to Hospice Care. In: Journal of the American Geriatrics Society. 2019.
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abstract = "OBJECTIVES: To quantify the frequency and type of medication decisions on discharge from the hospital to hospice care. DESIGN: Retrospective cohort study. SETTING: A 544-bed academic tertiary care hospital in Portland, Oregon. PARTICIPANTS: A total of 348 adult patients (age ≥18 y) discharged to hospice care between January 1, 2010, and December 31, 2016. MEASUREMENTS: Data were collected from an electronic repository of medical record data and a manual review of patients’ discharge summaries. Our outcomes of interest were the frequency and type of medication decisions documented in patients’ discharge summaries. Medication decisions were categorized as continuation, continuation but with changes in dose, route of administration, and/or frequency, discontinuation, and initiation of new medications. We also collected data on the frequency of patient/family in the participation of medication-related decisions. RESULTS: Patients were prescribed a mean of 7.1 medications (standard deviation [SD] = 4.8) on discharge to hospice care. The most prevalent medications prescribed on discharge were strong opioids (82.5{\%}), anxiolytics/sedatives (62.9{\%}), laxatives (57.5{\%}), antiemetics (54.3{\%}), and nonopioid analgesics (45.4{\%}). However, only 67.8{\%} (213/341) of patients who were prescribed an opioid on discharge to hospice care were also prescribed a laxative. Discharging providers made a mean of 15.0 decisions (SD = 7.2) per patient of which 28.5{\%} were to continue medications without changes, 6.7{\%} were to continue medications with changes, 30.3{\%} were to initiate new medications, and 34.5{\%} were to discontinue existing medications. Patients and/or family members were involved in medication decisions during 21.6{\%} of discharges; patients were involved in 15.2{\%} of decisions. CONCLUSION: Patients averaged more than 15 medication decisions on discharge to hospice care. However, it was rarely documented that patients and/or their families participated in these decisions. J Am Geriatr Soc, 2019.",
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AU - Kadoyama, Kirsten L.

AU - Noble, Brie N.

AU - Izumi, Shigeko

AU - Fromme, Erik

AU - Tjia, Jennifer

AU - McPherson, Mary Lynn

AU - Candrian, Carey B.

AU - McGregor, Jessina C.

AU - Ku, In Young

AU - Furuno, Jon P.

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N2 - OBJECTIVES: To quantify the frequency and type of medication decisions on discharge from the hospital to hospice care. DESIGN: Retrospective cohort study. SETTING: A 544-bed academic tertiary care hospital in Portland, Oregon. PARTICIPANTS: A total of 348 adult patients (age ≥18 y) discharged to hospice care between January 1, 2010, and December 31, 2016. MEASUREMENTS: Data were collected from an electronic repository of medical record data and a manual review of patients’ discharge summaries. Our outcomes of interest were the frequency and type of medication decisions documented in patients’ discharge summaries. Medication decisions were categorized as continuation, continuation but with changes in dose, route of administration, and/or frequency, discontinuation, and initiation of new medications. We also collected data on the frequency of patient/family in the participation of medication-related decisions. RESULTS: Patients were prescribed a mean of 7.1 medications (standard deviation [SD] = 4.8) on discharge to hospice care. The most prevalent medications prescribed on discharge were strong opioids (82.5%), anxiolytics/sedatives (62.9%), laxatives (57.5%), antiemetics (54.3%), and nonopioid analgesics (45.4%). However, only 67.8% (213/341) of patients who were prescribed an opioid on discharge to hospice care were also prescribed a laxative. Discharging providers made a mean of 15.0 decisions (SD = 7.2) per patient of which 28.5% were to continue medications without changes, 6.7% were to continue medications with changes, 30.3% were to initiate new medications, and 34.5% were to discontinue existing medications. Patients and/or family members were involved in medication decisions during 21.6% of discharges; patients were involved in 15.2% of decisions. CONCLUSION: Patients averaged more than 15 medication decisions on discharge to hospice care. However, it was rarely documented that patients and/or their families participated in these decisions. J Am Geriatr Soc, 2019.

AB - OBJECTIVES: To quantify the frequency and type of medication decisions on discharge from the hospital to hospice care. DESIGN: Retrospective cohort study. SETTING: A 544-bed academic tertiary care hospital in Portland, Oregon. PARTICIPANTS: A total of 348 adult patients (age ≥18 y) discharged to hospice care between January 1, 2010, and December 31, 2016. MEASUREMENTS: Data were collected from an electronic repository of medical record data and a manual review of patients’ discharge summaries. Our outcomes of interest were the frequency and type of medication decisions documented in patients’ discharge summaries. Medication decisions were categorized as continuation, continuation but with changes in dose, route of administration, and/or frequency, discontinuation, and initiation of new medications. We also collected data on the frequency of patient/family in the participation of medication-related decisions. RESULTS: Patients were prescribed a mean of 7.1 medications (standard deviation [SD] = 4.8) on discharge to hospice care. The most prevalent medications prescribed on discharge were strong opioids (82.5%), anxiolytics/sedatives (62.9%), laxatives (57.5%), antiemetics (54.3%), and nonopioid analgesics (45.4%). However, only 67.8% (213/341) of patients who were prescribed an opioid on discharge to hospice care were also prescribed a laxative. Discharging providers made a mean of 15.0 decisions (SD = 7.2) per patient of which 28.5% were to continue medications without changes, 6.7% were to continue medications with changes, 30.3% were to initiate new medications, and 34.5% were to discontinue existing medications. Patients and/or family members were involved in medication decisions during 21.6% of discharges; patients were involved in 15.2% of decisions. CONCLUSION: Patients averaged more than 15 medication decisions on discharge to hospice care. However, it was rarely documented that patients and/or their families participated in these decisions. J Am Geriatr Soc, 2019.

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