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Medication management is a vital part of a patient’s end-of-life care. It involves an in-depth assessment and understanding of the patient’s current medical condition, psychosocial history, past medication usage, and the patient’s current needs and goals for care. The  provision of the palliation of pain and other distressing symptoms, along with patient safety should be the primary objective of the Hospice Interdisciplinary Team/Group (IDT/IDG).

Per the Medicare Conditions of Participation (CoPs), every patient should undergo a comprehensive assessment which includes a drug profile that contains the patient’s current prescription and over the counter (OTC) drugs with a medication regimen review process. It is important to include herbal remedies in the drug profile due to interactions these may have with OTC drugs and prescription medications.

Drug profiles should be reviewed during every home visit by each nursing staff member (registered nurse [RN]/licensed practical/vocational [LPN/LVN]) that visits the patient. During the visits, simply asking the patient or caregiver if the patient is taking any new medications since the last visit may not be enough. The nursing staff should ask to see the medications the patient is currently taking since patients and/or caregivers may not remember all new medications or may become confused as to whether they have informed the Hospice of medications. Also, caregivers may or may not be familiar with the medications the patient may be taking. The nursing staff should also ask about medications that are no longer being taken by the patient.

The nursing staff completing the in-home review should compare each medication provided by the patient and/or caregiver with the drug profile. Other IDG/IDT members may learn of medication changes during conversations. If other IDG/IDT members learn of any medication changes, he or she should notify the RN Case Manager to ensure the drug profile is updated. This communication should be documented by the IDT/IDG member reporting the findings, as well as the RN Case Manger receiving the report to show collaboration.

To ensure ongoing compliance with the Medicare CoPs, the Hospice should be completing  audits on a routine basis to ensure that drug profiles are being updated with all medication changes mentioned in the clinical records. By being proactive, the Hospice not only reduces the likelihood of problems that may arise during the survey process, but they ensure the patient is provided with safe care and can provide real time education that may be needed for the patient and/or caregiver.