ePrescribing in Hospice Care: A Safer Way to Provide Patient Care
October 5, 2023
Hospice care made its way into the U.S. in the early 1970s as a new way to provide comfort and support to people nearing the end of their lives. It is not focused on cures but on relieving pain and other symptoms of chronic illness, old age, and deteriorating health, and it is more than just patient care. Hospice workers are also trained to help families better understand and cope with the end-of-life process.
This concept has existed for centuries, but the modern hospice movement began in the United Kingdom in the 1950s when Dame Cicely Saunders, a British physician, founded St. Christopher’s Hospice in London in 1967, considered the first modern hospice.
Saunders believed that dying people deserve to be treated with dignity and compassion and should not suffer. She also believed that hospice care should be provided in a home-like setting, where patients could be surrounded by their loved ones.
Hospice Care Today
According to the National Hospice and Palliative Care Organization (NHPCO), there were 5,058 hospice agencies in the United States in 2020. This number has increased steadily in recent years as more people become aware of hospice care’s benefits.
Hospice care is delivered in various settings, including the patient’s home, a hospice facility, a nursing home or a residential care facility, or a hospital. Many insurance plans cover it, and often, there are no out-of-pocket costs for patients who meet the eligibility requirements.
One of the most crucial aspects of care is medication management and the ability to prescribe controlled substances. Hospice patients often take a variety of medications to manage their pain and other symptoms, and it is essential that these medications are managed correctly.
Tips for medication management in hospice:
- Use ePrescribing to streamline the medication ordering and dispensing process
By allowing doctors to prescribe and send medications to the pharmacy electronically, hospice programs can drastically reduce errors by eliminating the need for handwritten prescriptions. This also helps speed up and improve communication between doctors and pharmacists, ensuring patients take the correct medications as prescribed.
- Ask pharmacists to review the patient’s medication list regularly
When treating multiple chronic conditions, a broad mix of medications is required. Recent studies show hospice patients average 15.7 medications at any time during admission. Depending on their condition, these therapies often change, and dosages are frequently adjusted. Most ePrescribing platforms have safeguards to catch drug-drug interactions or allergies if they are input into the EHR. The DoseSpot prescribing software does both and will send alerts to the prescriber when a medication could present a risk.
- Educate patients and their caregivers about the medications they are taking
Many patients can be in hospice care for months. This means their medication regimen changes over time, and there are many side effects and risk factors to monitor and track. Lines of communication should remain accessible and open. When there are questions, the provider, pharmacist, or social worker is often a good place to start.
“Medication management is a core competency for hospice care, and there are special considerations when you’re dealing with disease progression and changes in how patients’ systems metabolize certain drugs. Part of our role as a hospice-focused pharmacy benefit manager is helping our clients maximize comfort and safety. I always recommend leveraging technology to provide maximum visibility of patient medications for the hospice interdisciplinary team.”
Enclara Pharmacia, VP of Clinical Management – Ryan Krout, PharmD
Preventing medication errors for hospice patients
Typically, medication errors in hospice care are 0.1-1.0%. This is lower than the overall incidence of medication errors in healthcare settings, estimated at 2-10%. But, if your loved one is in hospice care, any error is too many.
The importance of getting the medication right for hospice patients cannot be overstated. Errors can have serious consequences, including pain, discomfort, and even premature death.
The most common of these can all be solved with ePrescribing:
| Error Type | How ePrescribing Helps |
| Dosage errors: When the wrong dose of a medication is prescribed | Look for ePrescribing tools with a dosage calculator available within the application or easily accessible |
| Administration errors: When a medication is given incorrectly, such as at the wrong time or by the wrong route | ePrescribing includes specific fields for prescriber notes where clear directions can be entered for the patient and then translated through the pharmacy with a medication consultation |
| Transcribing errors: When the medication order is incorrectly transcribed | The handwriting mystery is solved with the electronic transmission of a script directly to the pharmacy |
| Dispensing errors: When a medication is dispensed incorrectly, such as the wrong medication or the wrong strength | Although this type of error often happens at the pharmacy, ePrescribing leaves less room for miscommunication or misspellings of drug names, which can lead to dispensing errors |
“Hospice care is 24/7, and when you’re dealing with emergent needs it’s a race against the clock,” Krout said. “Hospices need to have systems and safeguards in place to ensure they’re getting the right medication to the right patient in the timeliest manner possible.”
You must implement a culture of safety in all patient interactions. Here are some additional things that your care teams can do to help get medication right for hospice patients:
- Develop a system for tracking medication orders and deliveries
With DoseSpot, this tracking system is built into your software. You will be able to see every prescription transmission and whether the pharmacy received it. It will also alert you to transmission errors. - Implement regular audits of medication orders and deliveries
DoseSpot has more than ten report types to understand and monitor prescriber behavior across the prescribing application. It also has the reporting necessary to meet the requirements of DEA audits for EPCS. - Provide training to staff on medication safety
Help your staff understand and proactively acknowledge red flags when they are presented.
Hospice pharmacies play a vital role in medication management and safe prescribing practices
Hospice pharmacies specialize in providing medications to patients who are receiving hospice care. They work directly with providers to ensure patients can access the medications they need to manage their symptoms and stay comfortable.
As experts in this form of healthcare, they do more than just dispense and deliver medications. Here are some additional benefits of a hospice pharmacy to the total healthcare landscape:
- Expertise: Hospice pharmacists have specialized training in prescribing medication to patients receiving hospice care. They are familiar with the medications that are typically used in hospice care and the side effects that can occur.
- Convenience: Hospice pharmacies can deliver medications to patients’ homes or other locations. This can be a convenient option for patients unable to travel to a pharmacy.
- Support: Hospice pharmacists offer support to patients and their caregivers. They can answer medication questions, provide emotional support, and help families and caregivers navigate the healthcare system.
According to a study published in the Journal of Pain and Symptom Management, hospice pharmacies dispense an average of 1.5 times more controlled substances than regular pharmacies due to the amount of pain medications prescribed. They also dispense a higher proportion of highly addictive and tightly controlled Schedule II substances than regular pharmacies. Most states now require a trackable ePrescribing platform for these prescriptions.
The clinical staff at these pharmacies also have a responsibility to help prevent medication errors, prescribe responsibly, and prevent the diversion of controlled substances.
At DoseSpot, we will continue working to provide the very best end-to-end ePrescribing platform that helps to prevent medication errors and ensure patients receive high-quality care. Request a demo if you want to see our ePrescribing software in action!