2023 April Coffee Chat-April 2023 Coffee Chat

Video Transcription

Video Summary

In this video transcript, the case of a hospice patient with chronic pain and respiratory failure is discussed. The patient has been taking high doses of oxycodone for chronic pain, but it is not providing sufficient relief. The patient is concerned that hospice will stop his pain medications. The discussion revolves around the need to rotate opioids for better pain control. Methadone is suggested as a possible alternative to oxycodone. The importance of differentiating chronic pain from other symptoms and creating a separate plan for managing it is highlighted. Concerns are raised about the patient's refusal to try other medications and the potential for drug diversion or abuse. The need for a pain contract to set clear expectations and consequences is emphasized. The importance of ensuring the safety of hospice staff when dealing with challenging patients and the consideration of discharging the patient for cause are also discussed. The conversation ends with a reminder of the regulatory requirement for healthcare providers to complete eight hours of opioid or substance abuse training for their next renewal or initial application. The need for continuing education and support for hospice medical directors is also brought up, with suggestions for annual hospice discipline meetings or other dedicated gatherings for hospice-focused discussions and training. The lack of such events is recognized, and the possibility of organizing a pre-conference workshop or finding other opportunities for hospice medical directors to come together is discussed.

Keywords

hospice patient

chronic pain

respiratory failure

oxycodone

rotate opioids

methadone

pain control

medication refusal

drug diversion

pain contract