Discussion- Make medications part of your discussion with the patient and their family, so that everyone understands the decisions that are made.
Necessity- Consider what medications are needed. Those intended for long term risk reduction (e.g. statins) are unlikely to be of benefit any longer. Those that may give symptomatic relief (e.g. regular pain relief, laxatives, PPIs, anti-anginals) may still be appropriate if patient is able to take them.
Dose- Patients who are opiate naïve or with renal impairment will need lower doses than those who have already been taking opiates. Think about frailty in older patients.
Anticipatories- Remember to prescribe prn anticipatory medications for pain, agitation, nausea and secretions. Just because a patient isn’t having these symptoms now doesn’t mean they won’t in the future! Check historic renal function and use renal prescribing guidelines if necessary.
Review and plan- Regular review of medications and routes. Things may need to be stopped or route changed if patient becomes too drowsy to take tablets. Make sure there is a clear plan from parent team for medications if patient is likely to deteriorate out of hours.
Syringe driver- If a patient is requiring multiple anticipatory meds throughout the day, consider whether a syringe driver may be more appropriate.
Mouth care- Remember that mouth care is something that needs prescribing and can give a lot of symptomatic relief.
Documentation- Make sure documentation of discussions with patients and relatives, decisions and future plans are clear in the notes. Useful for those caring for patients out of hours
Discharge – When discharging patients don’t forget to fill in the yellow discharge paperwork for anticipatory medications
THE INTERNIST
The internist should discuss
the prognosis with the patient
and consider limitation of therapy
when appropriate,
including ‘do not resuscitate’ (DNR) orders.
Internists should also be capable
of providing palliative care
at the end of life.
It is important that
they recognize the need
of acutely and chronically ill patients
for nutritional support
and physical therapy.
Internists should always strive
to avoid inflicting injury
on patients —
‘primum non nocere’.
https://web.archive.org/web/20210121023440/https://efim.org/system/files/corecompetenciesejimpub2007.pdf
Okay kan, Bro!
