title: Impact of a hospice emergency kit for veterans and their caregivers: a prospective cohort study.
abstract: BACKGROUND
  Although hospice emergency kits (HEKs) are provided by many home hospice agencies, little is known about their use, side effects, and perceived impact.
  
  
  OBJECTIVE
  To evaluate HEK medication utilization, side effects, and impact as perceived by home hospice patients and their caregivers.
  
  
  METHODS
  We conducted a prospective longitudinal cohort study. Participants included 43 veterans and their family/caregivers referred to community home hospices with a Veterans Affairs (VA)-provided HEK. Measurements included patient/family reports based on weekly telephone interviews, electronic medical record (EMR) review, and after-death caregiver interviews.
  
  
  RESULTS
  The HEK was used by 27 of 43 patients/caregivers (62.8%). In 11 cases, they reported using the kit on more than one occasion. The most commonly used medications were morphine concentrate (30.2% of patients), lorazepam (20.9%), and levofloxacin (16.3%). In 15 cases (34.9%), the family thought the HEK may have helped the patient stay at home. Nineteen of the 43 patients made at least one visit to the emergency department (ED) and 22 were hospitalized. Most admissions through the ED were due to uncontrolled pain and/or gastrointestinal problems, such as nausea or bowel obstruction. In after-death interviews, opinions of the HEK were uniformly positive. Respondents described the HEK's usefulness and felt supported and empowered by its presence in the home. Minor side effects were reported in four cases.
  
  
  CONCLUSIONS
  Findings provide promising evidence that HEKs are a feasible and well-tolerated method for achieving timely relief of emergent symptoms in home hospice patients and possibly avoiding unwanted ED visits and hospitalizations.
authors.affiliation: 1 Birmingham/Atlanta Geriatric Research , Education, and Clinical Center, Department of Veterans Affairs, Birmingham, Alabama, and Atlanta, Georgia .
authors.forename: F Amos
authors.initials: FA
authors.lastname: Bailey
authors.forename: Beverly R
authors.initials: BR
authors.lastname: Williams
authors.forename: Patricia S
authors.initials: PS
authors.lastname: Goode
authors.forename: Lesa L
authors.initials: LL
authors.lastname: Woodby
authors.forename: U Shanette
authors.initials: US
authors.lastname: Granstaff
authors.forename: Katharina V
authors.initials: KV
authors.lastname: Echt
authors.forename: David T
authors.initials: DT
authors.lastname: Redden
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kvale
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Burgio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D004638:Emergency Treatment / Q000295:instrumentation*; D005260:Female; D006699:Home Care Services; D017051:Hospice Care; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014481:United States; D014728:Veterans