Opioid pain medication orders and administration in the last days of life
Journal of Pain and Symptom Management, 07/10/2012
Bailey FA et al. – Findings indicate a need for improving availability of opioids for end–of–life care in the inpatient setting. Modifiable factors, such as family presence and goals–of–care discussions, suggest potential targets for intervention to improve recognition of the dying process and proactive planning for pain control.Methods
- Data on orders and administration of opioid pain medication at the end of life were ed from the medical records of veterans who died in six VAMC hospitals in 2005.
- Of 1068 patient records, 686 (64.2%) had an active order for an opioid medication at the time of death.
- Of these, 69.8% of patients had received the medication at some time within the last seven days of life, 61.2% within the last 48 hours, and 47.0% within the last 24 hours.
- In multivariable models, presence of an order for opioid pain medication at the time of death and administration within the last 24 hours were both significantly associated with having a Do Not Resuscitate (DNR) order (P<0.0001/0.0002), terminal condition (P<0.0001/<0.0001), family presence (P<0.0001/0.0023), location of death (P=0.003/0.0005), and having pain noted in the care plan (P=0.0073/0.0007).