It’s Time to Write the Order: A Practical Approach to Palliative Sedation (TH354)

Abstract

•Build a take-home guide of common medications for palliative sedation and how they can be applied to local practice cultures and specific patient situations.•Manage a patient needing palliative sedation in which midazolam either is ineffective or causes unwanted side effects.•Recognize and proactively address nursing concerns regarding the administration of palliative sedation in an interdisciplinary capacity. You’ve tried everything else. You’ve debated the ethical issues behind palliative sedation. You’ve talked with the patient and/or the patient’s family. You have brought together an interdisciplinary team to help everyone feel prepared and ready to start palliative sedation for the patient’s intractable symptom. Now it is actually time to order the medications and begin the procedure. Where, and, ultimately, what do you start? Palliative sedation is a true procedure for palliative care and hospice clinicians. While most symptoms are able to be alleviated through expert palliative care and hospice teams, intractable symptoms do occur and present a significant challenge to the team caring for these patients. The knowledge to perform and monitor palliative sedation allows clinicians the opportunity to relieve suffering and minimize the emotional burden of palliative sedation on interdisciplinary teams. Once the decision to begin palliative sedation is made, how to successfully perform this procedure is often influenced by availability of medications, the hospital or hospice culture where palliative sedation is performed, and by clinician experience and gestalt. This session will provide participants with a practical guide to medication selection and initial dosing, as well as best practices for titrating, monitoring, and documenting the effects of these medications. Using a case-based, interactive format, the presenters will also explore specific situations that may call for atypical medication regimens and will discuss emerging medications to keep in your palliative sedation armamentarium. This session also will explore common nursing concerns around the administration of palliative sedation and how to ensure that all members of the interdisciplinary team are supported while providing this high level patient care.