title: Opioid pain medication orders and administration in the last days of life.
abstract: BACKGROUND
  Most patients with serious and life-limiting illness experience pain at some point in the illness trajectory.
  
  
  OBJECTIVE
  To describe baseline pain management practices for imminently dying patients in Veterans Administration Medical Centers (VAMCs) and examine factors associated with these processes, including presence of opioid orders at the time of death and medication administration in the last seven days, 48 hours, and 24 hours of life.
  
  
  METHODS
  Data on orders and administration of opioid pain medication at the end of life were abstracted from the medical records of veterans who died in six VAMC hospitals in 2005.
  
  
  RESULTS
  Of 1068 patient records, 686 (64.2%) had an active order for an opioid medication at the time of death. Of these, 69.8% of patients had received the medication at some time within the last seven days of life, 61.2% within the last 48 hours, and 47.0% within the last 24 hours. In multivariable models, presence of an order for opioid pain medication at the time of death and administration within the last 24 hours were both significantly associated with having a Do Not Resuscitate (DNR) order (P < 0.0001/0.0002), terminal condition (P < 0.0001/< 0.0001), family presence (P < 0.0001/0.0023), location of death (P = 0.003/0.0005), and having pain noted in the care plan (P = 0.0073/0.0007).
  
  
  CONCLUSIONS
  Findings indicate a need for improving availability of opioids for end-of-life care in the inpatient setting. Modifiable factors, such as family presence and goals-of-care discussions, suggest potential targets for intervention to improve recognition of the dying process and proactive planning for pain control.
authors: Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, AL, USA.
authors: F Amos
authors: FA
authors: Bailey
authors: Beverly R
authors: BR
authors: Williams
authors: Patricia S
authors: PS
authors: Goode
authors: Lesa L
authors: LL
authors: Woodby
authors: David T
authors: DT
authors: Redden
authors: Theodore M
authors: TM
authors: Johnson
authors: Janice W
authors: JW
authors: Taylor
authors: Kathryn L
authors: KL
authors: Burgio
mesh_terms: D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005190:Family; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D010148:Intractable Pain / Q000188:drug therapy*; D016414:Resuscitation Orders; D012959:Socioeconomic Factors; D013727:Terminal Care / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D000701:Analgesics, Opioid