Palliative Care Intervention for Choice and Use of Opioids in the Last Hours of Life

Background. The purpose of this study was to evaluate the effects of a multicomponent palliative care intervention on choice and use of opioid pain medications for symptom control for patients dying in an acute care inpatient setting. Methods. A preintervention/postintervention trial was conducted between 2001 and 2003. Participants were physician, nursing, and ancillary staff of inpatient services of an urban, tertiary care Veterans Affairs (VA) Medical Center. The intervention included staff education to better identify actively dying patients and a Comfort Care Order Set to guide care in the last hours of life. Data abstracted from computerized medical records of 191 veterans who died during a 6-month period before (N = 98) and after (N = 93) the intervention were used to examine changes in choice and amount of medication administered in the last 3 days of life. Results. Findings show a significant increase in orders specifically for morphine from 47.4% to 81.7% (p