Palliative Medicine basics
True or False
A 47-year-old with recent diagnosis of metastatic breast cancer is a good patient to refer to palliative medicine for symptom management and advance care planning.
A patient is eligible for hospice if they have life limiting illness, are not pursuing curative treatment, and have a prognosis of this time interval.
6 months
This medical condition might cause you to reconsider prescribing a patient Norco (Hydrocodone 5 mg/ Acetaminophen 325 mg) 2 tablets every 4 hours as needed.
cirrhosis
This dose of short acting hydrocodone would be considered a "starter" dose for someone of normal weight and height and in their 40's.
5 mg
This common insurance never pays for someone to be on 2 funded services at the same time.
Medicare
A patient is not appropriate for Palliative Medicine consultation in the hospital until they have exhausted all treatment options and need to be told "there is nothing more to be done".
FALSE!!!
The level of care in hospice that allows a patient to be placed into a facility for 5 days in order to give a caregiver a break.
respite level of care
This percentage is the maximum recommended dose not to exceed when increasing an opioid for severe pain with any single adjustment.
100%
5 mg
This common insurance does not have subacute (SNF) coverage nor LTAC hospital coverage.
Medicaid
Documentation of these three items in the H and P at the time of admission would be greatly helpful over the course of a hospital stay, particularly in patients with chronic illness and concern for waning capacity to make decisions.
1- Advance Directive or POLST
2-Healthcare Decisionmaker
3-code status
The need for frequent doses of IV medications to control severe symptoms is criteria to qualify for this level of hospice care.
general inpatient (GIP)
List these medications from weakest to strongest based on equianalgesic dosing of their oral version.
1-morphine
2-hydromorphone
3-meperidine
4-oxycodone
meperidine (300 mg)
morphine (30 mg)
oxycodone (20 mg)
hydromorphone (7.5 or 8 mg, depending on reference)
This would be a reasonable dose of morphine to convert to if a patient is currently taking 10 mg of po oxycodone and you were to drop the dose by 1/3 for incomplete cross tolerance.
10 mg
This is the number of hospital inpatient days that a patient must stay to qualify for placement in a subacute rehab facility under Medicare.
3
Which of these patients is NOT a good candidate for palliative medicine consultation?
1-32-year-old female with metastatic cervical cancer with difficult to control pain
2- 67-year-old male with end stage heart disease that is having trouble accepting his terminal illness.
3- 66-year-old male admitted for pneumonia with chronic back pain
3
The hospice per diem covers all but which one of the below:
1- medications related to the terminal illness
2-DME equipment
3-clinical physician visits approved by the hospice
4- hospice staff visits
clinical physician visits
Without decreasing dose for incomplete cross tolerance, this is the milligram strength of oral morphine needed to be equianalgesically the same as 10 mg of oral hydrocodone.
10 mg
This would be a reasonable starting dose of long-acting morphine if a patient is consistently averaging 30 mg of short acting morphine over 24 hours.
This discharge plan option requires a patient be homebound except for doctor's appointments, church, and other similar life functions.
Home Health
True or False
Research shows that patients do not live as long after palliative medicine is consulted when compared to similar patients without palliative medicine consultation.
False
True or False:
In order to access the Medicare Hospice Benefit, Medicare patients must choose to give up hospital coverage for conditions related to their terminal prognosis.
True
The total amount of short acting opioid used over this time interval is needed to safely know whether someone qualifies to start a long-acting opioid.
24 hours
This would be a reasonable fentanyl patch starting dose if a patient was consistently taking morphine 55 mg daily of short acting oral morphine. (you drop dose by 1/3 for incomplete cross tolerance)
This permanent placement option at discharge does not provide "medical" services and a patient must still be able to at least partially participate in providing for their own activities of daily living such as bathing and dressing. It is also not covered by any insurance plans.
Assisted Living