Medications are a common tool used to manage pain and other troubling symptoms in hospice care. However, it is crucial to have a thorough understanding of the medications prescribed to you. This includes knowing how much to take, when to take them, why you are using them, and any potential side effects that may occur. It is essential to discuss all medications, including herbal supplements, with your healthcare team and pharmacist to ensure proper management.

Organization is Key

To effectively manage medications, it is important to keep track of what is being taken and when they are to be given. Ideally, one person should be responsible for handling medication administration and creating a system, and any visitors that assist should work within this established system.

If you are assisting someone with taking oral medications like pills, capsules, or tablets, there are a few guidelines to follow for safe administration.

1. Wash your hands before handling any medication.
2. Ensure the person is sitting comfortably and upright to make swallowing easier. Offer them a drink of water to moisten their mouth and make swallowing more comfortable.
3. Read the medication instructions and follow any specific instructions for giving the medication, such as taking it with or without food.
4. If the person has difficulty swallowing pills, consider mixing them with applesauce, jam, ice cream, or pudding. However, it is important to check with the hospice team before altering medications, as some medications should not be crushed or removed from their capsule. In some cases, alternative methods of medication delivery may need to be considered if a loved one cannot swallow as highlighted below.

As Needed Medications

Frequently, pain relievers or other medications are prescribed to manage symptoms that arise between scheduled doses of medication. These medications are commonly referred to as “breakthrough medications,” “rescue doses,” “PRN,” or “as needed” medications. It is beneficial to document and keep track of the what is happening when as needed medications are needed. This information can assist your healthcare team in determining whether medication adjustments are necessary. Pay attention to the following:

1. A description of the symptom. Use clarifying questions as below:

• • • • “What are you feeling?”
      • “How intense is the feeling?”
      • “Where are you feeling this?”
      • “Rate this feeling from 0 (none) to 10 (worst).”

2. Was medication needed? If so what medication and how much.

3. How effective was the medication in treating the symptom. Ask questions like:

• • • • “On a scale of 0 (none) to 10 (completely) how much relief did you experience from (symptom).”
      • “How quickly after the medication did you feel relief?”

4. Note anything occurring at the time of the symptom onset. What was the individual doing and how did that make them feel?

Alternatives to Swallowing

As the end-of-life approaches, swallowing may become more challenging. This may be due to the disease progression, general weakness, or decreased alertness. Coughing or a sensation of choking during or after eating or drinking may be one of the first indications that swallowing is becoming problematic. If you observe this happening, inform the hospice team.

When swallowing medication is no longer feasible, the healthcare team may explore other methods of administering medication. There are numerous alternatives available as detailed below.

Sublingual (Under the tongue) or Buccal (through the lining of the mouth)

Sublingual administration involves placing a liquid or pill under the tongue, while buccal administration involves placing it in the space between the cheek and gums, typically towards the back of the mouth. This allows the medication to be absorbed into the bloodstream through the blood vessels in the mouth.

It is important to administer only a small amount of medication at a time, typically no more than 1 milliliter (1cc). If the dose is greater than 1 milliliter, it should be divided into two doses and given 5 to 10 minutes apart. 

Intranasal Administration

Intranasal administration involves squirting a liquid medication in the form of a mist into the nose. The medication is then absorbed into the vessels in the nose and circulated throughout the body. The benefit of intranasal medication is that is generally well tolerated and rapid acting. Typically, only 1 milliliter (1cc) of medication can be given into each nostril at a time and larger doses can be separated and administered separately (one spray in each nostril).

Subcutaneous (Under the skin’s surface)

Subcutaneous medication administration involves injecting medication into the fatty tissue layer beneath the skin using a needle and syringe. This route of medication administration can provide a slow and steady release of medication into the bloodstream, leading to a longer duration of action. Subcutaneous injections are commonly used for insulin, heparin, and some vaccines. Proper technique and site selection are important to ensure accurate dosage and minimize discomfort and complications.

Transdermal (Through the skin)

Another method of medication administration is the transdermal route, which involves applying medication directly to the skin. This can be done through a lotion or gel, or via a patch. Transdermal administration is commonly used for pain medications and anti-emetics (nausea medications).

The fentanyl patch is a commonly used pain medication patch for individuals who suffer from stable, chronic pain and require scheduled pain medication. Often times, this can be from a cancer-related severe pain. It is crucial to follow the instructions on the packaging and change the patch as directed by your physician. It is also important to avoid getting the patch wet and to dispose of it properly to prevent harm to children or pets.

Rectal Administration

Rectal administration involves administering medications through the rectum and the large intestine, where the medication is absorbed. Prior to administration, it is important to ensure that there is no stool in the rectum, as medication administration via the rectal route may cause the person to have a bowel movement and force out the suppository before it is fully dissolved.

To administer a suppository, you will need a glove and lubricating jelly ( or petroleum jelly (Vaseline®)). After lubricating the suppository well, the suppository should be pushed as far as possible into the rectum by the gloved forefinger. While the rectal route is highly effective, it is usually a last resort due to concerns about the dignity of the person receiving the medication.

How We Utilize Medications at Honor Hospice

At Honor Hospice, we prioritize the assessment of each patient’s functional ability and utilize the most effective medication to meet their unique needs. Our approach is grounded in evidence-based interventions that aim to achieve optimal symptom management with minimal medication and side effects. We understand the importance of patient preference and actively involve them in the decision-making process when selecting medications. Our goal is to provide compassionate care that enhances the quality of life for our patients and their families.

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