• J Pain Symptom Manage · Dec 2018

    Breakthrough Medication in Unresponsive Palliative Care Patients: Indications, Practice, and Efficacy.

    • Michael Barbato, Greg Barclay, Jan Potter, and Wilf Yeo.
    • Palliative Care Services, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia. Electronic address: michael.barbato6@gmail.com.
    • J Pain Symptom Manage. 2018 Dec 1; 56 (6): 944-950.

    ContextAn unresponsive patient's need and their response to breakthrough medication is determined by clinical assessment and/or observational measures. How closely these methods match the patient's experience is unknown.ObjectivesDetermine the efficacy and effectiveness of breakthrough medication in unresponsive patients and the perception of patient comfort made by nurses and family.MethodsA prospective study of breakthrough medication in unresponsive patients. The Richmond Agitation-Sedation Scale (RASS) and Patient Comfort Score (PCS) were compared with time-matched Bispectral Index (BIS) Scores. The effects of opioid vs. opioid + benzodiazepine breakthroughs and the relation between synchronous nurse and family measurements of the PCS were evaluated. Analysis of variance and paired t-tests were used for BIS analyses and nonparametric Mann-Whitney tests for RASS and PCS.ResultsSignificant reductions at 30 and 60 minutes after breakthrough medication were noted for BIS (P < 0.0004), RASS (P = 0.043 and 0.004, respectively), and PCS (P < 0.0004). A direct comparison of the effect of opioid breakthrough medication vs. opioid plus benzodiazepine revealed no significant difference (BIS, P = 0.512; RASS, P = 0.195; PCS, P = 0.119). Of the 157 synchronous nurse and family measures of patient comfort, families rated patient discomfort significantly higher than nurses (P < 0.0004).ConclusionThis study provides additional evidence for the efficacy and effectiveness of breakthrough medication and the merit of observational measures in determining a patient's response. The onset of action is evident at 30 minutes after injection. Family assessment of patient comfort may be more nuanced than that of nurses, and they not uncommonly rate patient discomfort higher than nurses.Copyright © 2018 American Academy of Hospice and Palliative Medicine. All rights reserved.

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