title: Medication kits for managing symptomatic emergencies in the home: a survey of common hospice practice.
abstract: BACKGROUND
  Alleviation of symptoms associated with advanced illness and dying is a fundamental goal and core principle of palliative care. Little research exists regarding hospice programs' practices for prescribing, dispensing, and utilizing medication kits in the home for management of uncontrolled symptoms.
  
  
  METHODS
  We conducted a telephone survey of all 22 agencies in New Hampshire providing home hospice care. The survey inquired about the timing of medication kit ordering and availability, characteristics of prescribers and pharmacies, kit contents, costs, frequency of use, and perceived impact of kits.
  
  
  RESULTS
  All programs' kits contained medications to treat pain and dyspnea, 81% for nausea and vomiting, and 76% for seizures. Eighty-six percent of agencies (18/21) reported that a medication within the kits was used in more than 50% of cases. Eighty-six percent reported the kits often averted hospital or emergency department visits. Oral, sublingual, and rectal routes of administration were common as was topical preparations of combination medications. Three programs included parenteral morphine in kits. Kits cost less than $50 for the majority of programs.
  
  
  CONCLUSIONS
  Hospice programs commonly utilize kits containing prescription medications for the purpose of managing uncontrolled symptoms in the home. There is considerable variation in kit contents and practice. Programs believe that kits diminish emergency department visits and hospitalizations. Research is needed to more fully describe and study the outcomes of these practices.
authors.affiliation: Department of Palliative Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire 03756-0001, USA. margaret.f.bishop@hitchcock.org
authors.forename: Margaret F
authors.initials: MF
authors.lastname: Bishop
authors.forename: Lisa
authors.initials: L
authors.lastname: Stephens
authors.forename: Martha
authors.initials: M
authors.lastname: Goodrich
authors.forename: Ira
authors.initials: I
authors.lastname: Byock
mesh_terms: D003625:Data Collection; D004630:Emergencies; D006699:Home Care Services; D017051:Hospice Care; D006801:Humans; D007407:Interviews as Topic; D009513:New Hampshire; D010166:Palliative Care; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*
chemical_list: D004364:Pharmaceutical Preparations