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Evaluating the Pharmacological Management of Terminal Delirium in Imminently Dying Patients With and Without the Comfort Measure Order Set

Sutherland, Megan BScN, RN; Stilos, Kalli (Kalliopi) MScN, BScN, RN, CHPCA(C)

Journal of Hospice & Palliative Nursing: October 2019 - Volume 21 - Issue 5 - p 430–437
doi: 10.1097/NJH.0000000000000585
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Terminal delirium is a distressing irreversible process that occurs frequently in the dying phase, often misdiagnosed and undertreated. A previous study in our organization revealed that terminal delirium was a poorly managed symptom at end of life. Pharmacological options are available in an existing order set to manage this symptom. The management plans of 41 patients identified as having terminal delirium were further evaluated. Elements extracted included medications prescribed to manage terminal delirium, whether medication changes occurred, and whether they were administered and effective. Patients with the order set were more comfortable as compared with the group without. Both groups had several changes made by the palliative care team. Nurses did not administer prescribed as-needed medication to more than one-third of patients. Modifications will be made to the existing order set, and additional education for staff will be organized.

Megan Sutherland, BScN, RN, is registered nurse in critical care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

Kalli (Kalliopi) Stilos, MScN, BScN, RN, CHPCA(C), is advanced practice nurse in palliative care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

Address correspondence to Kalli (Kalliopi) Stilos, MScN, BScN, RN, CHPCA(C), Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5 (kalli.stilos@sunnybrook.ca).

The authors have no conflicts of interest to disclose.

Online date: July 26, 2019

© 2019 by The Hospice and Palliative Nurses Association.