PHARMACISTS FIND PURPOSE IN END-OF-LIFE CARE

During residency at the University of Washington in Seattle, Traci White, PharmD, spent a lot time on rotations ICU as part team providing intensive care to critically ill patients. What struck her about this work, she said, was “You’re looking paper, numbers, data, and graphs. You’re talking patient’you’re discussing everything that patient. But you have no idea who patient really is.” That’s what missing for White’the connection. ultimately led end-of-life care. “I wanted make connections with patients, I gravitated toward symptom management,” said. find any way could their life better while going through these horrible things, like cancer.” Pharmacists are critical members team. Their key focus is alleviate pain other discomfort end life. That can mean adding medications, recommending different formulations or routes administration, deprescribing medications longer needed. End-of-life pharmacists counsel educate patients families all changes—sometimes right bedside. While Board Pharmacy Specialties does not certify palliative care, practice field get necessary skills pharmacy school, hospital residencies, training from supporting organizations such Society Pain Palliative Care Pharmacists. According Specialties, demand management experts hospice rise. begins when decides they want pursue treatment fight terminal health condition. The benefits patient, it may cause adverse effects diminish patient’s remaining quality At life, help comfortable possible so don’t spend suffering even feel well enough enjoy left. Achieving those goals managing pain, nausea, shortness breath, depression, anxiety, symptoms. “Not everybody phase where sleeping time,” said Jessica Geiger, BCPS, clinical pharmacist OhioHealth Riverside Methodist Hospital Columbus. “Some people still up, active, moving around doing but they’re struggling insomnia.” drugs used manage types symptoms, unlike some treat diseases, direct typically swift impact Many specialize say most gratifying work. “You them better,” Marliese Gibson, BCPP, coordinator OhioHealth’s Kobacker House, an in-patient center. hypertension cholesterol—those treatments very important—but necessarily just because blood pressure bit lower.” Key players teamA pharmacist’s expertise pivotal inclusion every given.For starters, Medicare requires receive comprehensive medication review enter routinely thereafter, federal agency doesn’t require it’s job.“Most strongly should consider us integral parts interdisciplinary team,” Geiger “Who someone’s than trained years college nothing medications?”While state-recognized provider status helps move needle direction, resolve problem.In New Mexico, recognized clinicians, White says distinction raises profile among families. “It makes more open providers, either physician extender added layer support team.”But after Mexico’s clinician title came be H.B. 42, passed last year, allowed reimbursed by state commercial insurers. Still, without recognition, Medicare, payer covers significantly large proportion will reimburse services.In Ohio, Gibson practice, bill made providers signed into law 2019, has taken systems update practices reflect that. Those changes works now. Change never happen, buy-in.“Pharmacists shout rooftops we great do until disciplines say, ‘Our things’ change starts happen.” In meantime, “Continue demonstrate your worth.” A given. For job. “Most medications?” problem. team.” services. buy-in. “Pharmacists To determine dosage provide optimum during final days months, consult nurse in-home work directly Alifia Waliji-Banglawala, directory services Dimensions, home service Danvers, MA, often consults nurses call bedsides. “They ask question morphine how administer Keppra trouble swallowing,” Waliji-Banglawala “When give answer, know there immediate benefit.” These calls bedside emphasize “Hospice added. see extended period time, collaborate bedside—physicians, nurses, social workers, aides—and take. We sounding board each other, love being oftentimes, understand symptoms recommend. Though major issue person’s many preconceived notions resistant seeking relief. It’s common worry, little left, become addicted opioid painkillers if accept them. “’But opioids.’ statement times, breaks my heart,” explains that, context, strong medically addiction unlikely. If themselves concern, fear children disapprove taking opioid. Often difficult convincing stopping certain they’ve decades. It hard let go admit “They’ve one decision—either enrolling choosing, example, stop chemotherapy—and then another decision,” factor improving reducing now-unnecessary also pill burden. Patients “But doctor told me needed take rest life,” “That’s what’s keeping alive” pressure, cholesterol, chronic medications. concerns, “That important sense years, did job now, moment, less important.” When comment half-hour swallow pills, stresses anymore to. Inhalers go. lung cancer, COPD, end-stage heart failure getting oxygen, inhalers solution. “These long-acting 30-, 40-, 50-, 60-year-olds use, older adult capacity inhale deeply lungs. ending up back throat,” agree switch nebulizer, “We life.” easy case believe inhaler alive. Waliji-Bangawala received couldn’t convince clearly his inhaler, try nebulizer. decided visit herself. Belligerent first, he didn’t hear had say. He inhaler. asked watch struggled draw medication. him strain muscle torso two puffs,” recalled. demonstrated proper use She left next day felt. Still angry, would once wasn’t called and, begrudgingly, nebulizer worked few months later, got unexpected “He ‘I’m calling trust opinion: Which flu shot get?’” caring means family, too. address needs. family exhausted caregivers themselves. They jobs responsibilities loved one. Better clinicians ease burden “It’s heartwarming functioning rather nurse. fulfilling,” Family complex Particularly COVID-19, cannot hospital, greater lengths bring relatives home, education. vast majority our oral home,” concentrated liquids, mistaking 0.25 mL 2.5 significant dosing difference, sure educated this.” might need education administering I.V. S.C. look prompt out for, anxious prescribers add new meds old ones away. harbor fears misconceptions do. deal counseling issues. This devoted attention making COVID-19 vaccines safely together wishes.