When a loved one is in hospice care, family members and caregivers need to make difficult, often emotional decisions. This often comes after an already-long road of supporting your loved one as they battle disease or through declining health. As a caregiver, you need to make sure your loved one is comfortable and getting everything they need, while retaining a sense of independence and dignity. To answer that need, a critical component of hospice treatment is palliative care, which is designed to make sure your loved one remains comfortable by relieving pain, alleviating symptoms, and reducing the overall stress associated with critical care.
What Are Hospice Medicine Services?
Hospice care begins when a patient, their family, and their medical team decide curative options are either no longer available, feasible, or worth the side effects. This service can be recommended when a patient has a chronic disease or terminal illness. Palliative care is a closely associated type of comfort care that may or may not have curative intent. During hospice or palliative care efforts, a compounding pharmacy for hospice can ensure your loved one receives the best combination of medicine to reduce the pain and unpleasant symptoms they may be experiencing.
Teamwork is an integral part of hospice care, and it benefits patients and practitioners alike. Crawford GB, Price SD. (2003). Team working: Palliative care as a model of interdisciplinary practice. Med J Aust. 179(S6), S32-4. Including a compounding pharmacist on your loved one’s hospice care team is vital and can result in increased comfort for the patient and peace of mind for you. Nausea, for instance, is a common problem for hospice patients. The ability to relieve nausea by compounding anti-nausea medication is just one example of how including a compounding pharmacist on your loved one’s care team can improve the quality of life in this stage. Jones M. (2006). Hospice from a Compounding Pharmacist’s Perspective. International journal of pharmaceutical compounding, 10(2), 89–93. Pharmacists have the patient’s best interest in mind when it comes to making sure the proper types of medications are delivered. To this end, a compounding pharmacist can compound medication to ensure all necessary medicines are being delivered in a form that is not only accessible but comfortable for your loved one.
What Is Medicine Compounding?
The compounding of medication is the preparation of a custom formulation of medicine to meet the unique needs of a patient that cannot be met with commercially available medications. Unique needs could include specific requirements regarding the ingredients of the medication, the delivery of the medication, or a combination of both.
Medicine compounding is especially relevant in hospice and palliative care because of the many special considerations that come with managing the multiple symptoms many patients experience in this stage of care. When your loved one is in hospice care, they may experience difficulty with the way certain medications are administered. For example, hospice patients frequently experience difficulty swallowing or new aversions to the unpleasant taste or texture of their prescription. The innovation of compounding pharmacists can often lead to a solution for these, and other, challenging treatment problems. McNulty, J. P., & Muller, G. (2014). Compounded drugs of value in outpatient hospice and palliative care practice. International journal of pharmaceutical compounding, 18(3), 190–200. In this way, the use of compounding medicine leads to more effective, personalized care.
In addition to compounding medications for symptom management, compounding for side effect management is important as well. Nobody wants their loved one to sacrifice one form of comfort to obtain another. For example, commercially available pain medication may result in a side effect of low appetite, meaning your loved one has no desire to enjoy their favorite foods. Using medicine compounding techniques, a compounding pharmacist can work to prepare a formula that eliminates low appetite while managing pain levels, allowing your loved one to enjoy eating their favorite foods during this time.
Why Are Hospice Compounding Pharmacy Services Important?
While a person is experiencing hospice medicine services, all members of the team, including the patient themselves, develop a focus on symptom and side effect management. This stage of life is difficult emotionally for patients and their families, and it is especially important to make sure your loved one can remain as physically comfortable as possible during this time. Pain is a common symptom of hospice patients, but it is certainly not the only one. Symptoms of the illness or disease can be treated using compounding medicine, as can residual symptoms and side effects.
Possible residual symptoms include:
- Loss of appetite
- Difficulty sleeping
Hospice compounding pharmacy services are extremely important when it comes to supporting your loved one in this stage of their life. A compounding pharmacist will work with the patient, family, and care team to develop and implement a treatment plan that treats the whole person—not only the symptoms related to the illness. The mission should be to create an overall sense of well-being for both body and mind.
How Does Compounding Increase Comfort?
The art and science of preparing customized compounded medication formulations leads to the delivery of personalized care to patients in hospice. Herndon, C. M., Nee, D., Atayee, R. S., Craig, D. S., Lehn, J., Moore, P. S., Nesbit, S. A., Ray, J. B., Scullion, B. F., Wahler, R. G., Jr, & Waldfogel, J. (2016). ASHP Guidelines on the … Continue reading A compounding pharmacist can help increase your loved one’s comfort in many ways, depending on their individual needs. Some possibilities include:
Often, in the hospice setting, commercial medications aren’t strong enough to manage the pain your loved one is experiencing. We can create customized medication strengths to increase comfort.
Altering Medication Taste
In this stage of life, many patients experience an aversion to certain tastes, which makes taking medication difficult. We can develop more palatable medications when commercial alternatives are not available by adding customized flavorings.
Alternative Administration Forms
Your loved one may be having trouble swallowing pills, or it may be unsafe or uncomfortable to take medications orally. Administration of injections may also prove too painful or uncomfortable. With a compounding pharmacist, there are other options. Compounded medication can be created in many forms, including liquid, troches, ointments, creams, lollipops, lozenges, mouthwashes, or suppositories.
Taking several medications can take a lot of time and careful scheduling to ensure accurate dosing. It can also negatively impact your loved one’s energy levels, leading to a lack of desire to participate in meaningful activities and a reduced quality of life. A compounding pharmacist can combine several medications into a single dose.
Access to Unavailable Medications
Being without a crucial medication can lead to extreme discomfort or a decrease in a patient’s quality of life. We can create medications from raw ingredients if they are unavailable due to manufacturing issues or provide medications that have been discontinued.
If your loved one is allergic to the preservatives or dyes present in many commercial medications, they should not have to experience ill side effects to remain pain-free. We can create medications that are free of those irritants.
Decreasing Physical Discomfort
Hospice patients are susceptible to pressure sores due to a variety of factors that are specific to this population including immobility, incontinence, and decreased nutrition. Sternal, D., Wilczyński, K., & Szewieczek, J. (2016). Pressure ulcers in palliative ward patients: hyponatremia and low blood pressure as indicators of risk. Clinical interventions in aging, 12, … Continue reading Our compounding pharmacists can formulate individualized medication to relieve pain and support healing associated with pressure sores.
Which Terminal Conditions Benefit From Compounding Medications?
Almost any person in hospice care could benefit from compounding pharmacy for hospice due to the number of symptoms they likely experience. Talking with your provider or compounding pharmacist is worthwhile no matter what diagnosis your loved received. Because of the individualized nature of each hospice patient, there is not a one-size-fits-all care plan. Some of the more common illnesses seen in hospice patients and how they could benefit from medicine compounding include:
Compounding medication can help patients reduce discomfort caused by previous cancer treatment and increase comfort and quality of life. For example, radiation may have caused thrush in the mouth, which is uncomfortable and can contribute to a loss of appetite.
Compounding pharmacists can help reduce discomfort associated with declining function. For example, dementia may lead to difficulty swallowing. We can create compounded medications that can be delivered topically to reduce the risk of choking while taking medication orally.
The three most common sources of discomfort in the advanced stages of heart disease are dyspnea, depression, and pain. Lemond, L., & Allen, L. A. (2011). Palliative care and hospice in advanced heart failure. Progress in cardiovascular diseases, 54(2), 168–178. We can work with your loved one’s medical team to develop a personalized medication that addresses fluctuating pain and depression levels.
Common symptoms for patients with end-stage COPD include dyspnea, fatigue, and pain. Taking medications orally can be exhausting for patients who are already out of breath and having trouble breathing. We can work to develop compounded topical medications to avoid the need to repeatedly take oral medications, increasing comfort.
Trustworthy Hospice Compounding Pharmacy Services
Customized medication blends could be delivered in the form of a pill, if that is what the patient prefers, and the care team determines is best. We can create lollipops, creams, suppositories, or transdermal compounding forms that can be applied to the skin. We can provide medications in unique or customized dosages to best meet the needs of your loved one, which is important when patients can no longer swallow pills or have no desire to continue receiving painful injections.
Families benefit from custom medications, rather than relying on other companies that may be experiencing shortages. This means your loved ones will have what they need all the time, without being impacted by delays commercial suppliers face.
*Editor’s Note: This article was originally published Jun 26, 2014 and has been updated May 4, 2022.
Chief Operating Officer, The Compounding Pharmacy of America
Matthew Poteet, Pharm.D. graduated with Honors from Lee University with a Bachelors of Science in Biological Science. After his undergraduate training, he completed the Doctor of Pharmacy program at Mercer University Southern School of Pharmacy, graduating in 2004. Dr. Poteet has spent much of his pharmacy career on staff at two of the most prestigious academic teaching hospitals in the Southeast; Emory University in Atlanta and Vanderbilt University Medical Center in Nashville. At these institutions he received extensive experience and training in sterile products compounding.
He returned home to East Tennessee in 2010, where he has held the position of Pharmacy Director at two sterile products pharmacies in Knoxville. Matthew lives in Knoxville with his wife, Chris. Dr. Poteet is Tennessee’s first Board Certified Anti-Aging Pharmacist by the American Academy of Anti-Aging Medicine.
|↑1||Crawford GB, Price SD. (2003). Team working: Palliative care as a model of interdisciplinary practice. Med J Aust. 179(S6), S32-4.|
|↑2||Jones M. (2006). Hospice from a Compounding Pharmacist’s Perspective. International journal of pharmaceutical compounding, 10(2), 89–93.|
|↑3||McNulty, J. P., & Muller, G. (2014). Compounded drugs of value in outpatient hospice and palliative care practice. International journal of pharmaceutical compounding, 18(3), 190–200.|
|↑4||Herndon, C. M., Nee, D., Atayee, R. S., Craig, D. S., Lehn, J., Moore, P. S., Nesbit, S. A., Ray, J. B., Scullion, B. F., Wahler, R. G., Jr, & Waldfogel, J. (2016). ASHP Guidelines on the Pharmacist’s Role in Palliative and Hospice Care. American journal of health-system pharmacy: AJHP, official journal of the American Society of Health-System Pharmacists, 73(17), 1351–1367.|
|↑5||Sternal, D., Wilczyński, K., & Szewieczek, J. (2016). Pressure ulcers in palliative ward patients: hyponatremia and low blood pressure as indicators of risk. Clinical interventions in aging, 12, 37–44.|
|↑6||Lemond, L., & Allen, L. A. (2011). Palliative care and hospice in advanced heart failure. Progress in cardiovascular diseases, 54(2), 168–178.|