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Next Reply: Re:Use of VAlium for end of life restlessness
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Post Use of VAlium for end of life restlessness
Author: gailcousineau
Date: Oct 4, 2007 8:22 pm
We continue to use Valium Suppositories for end of life restlessness even when the pt no longer demonstrates restlessness, as a preventative practice, to prevent reoccurance. How do you document this continued use that is acceptable to JC and Medicare?
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+ Re:Use of VAlium for end of life restlessness (by mrabow on 12/06/2007)
I'd welcome comments from others but I think it is key to document, with any intervention, that it is consistent with safety goals. Both Medicare and JCAHO are very focused on promoting safety, with fall prevention as a particular focus. Any use of benzodiazepines, especially in the elderly, would need to document very carefully that patients are not being sedated by the med and are not experiencing an increased risk of falling. I do not know of any medicare or JCAHO regulations around prevention of terminal restlessness.
Best,
Michael Rabow, MD, Associate Direcdtor, UCSF Palliative Care Leadership Center.
+ Re:Use of VAlium for end of life restlessness (by rnielsen on 06/19/2009)
How well is the valium working for you?

We use Ativan, which I have found very dissappointing. Half the time it makes the patient worse, and if it works, you have to sedate the patient into unconsciousness before they stop shouting or crawling out of bed.

Terminal delirium may be different than sepsis/hospital related delirium, but in sepsis induced delirium, brain dopamine levels are high and acetylcholine levels are low, and I have been having a better response from Haldol 1-3 mg now and tid (routine), and donepizel/Aricept 5 mg now and q pm. than I ever got with prn dosing of haldol or with haldol alone.

Terminal delirium may be different in that reticular activating system failure is at least part of what is going on. In one case I had excellent results adding Ritilan 5 mg po @ 8:00, 10:00, 12:00, 2:00. The patient woke up and remained responsive to the family until just a few hours before death.

It can be hard to convince a nurse to give Ritalin to an agitated patient, but it is kind of like ADD. Improved RAS function is calming.

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