53 - Assessing Conversion to Transdermal Fentanyl (TDF) or Methadone During Transition on Hospice Admission
Sulgi Chae1, Kathryn Walker2, Mary Lynn McPherson1
1University of Maryland School of Pharmacy, Baltimore, MD, USA. 2MedStar Health Palliative Care Medicine, Baltimore, MD, USA
Purpose This study determined if TDF/methadone dose transitions are done appropriately in the week prior to transition from hospital to hospice setting Methods Patients were retrospectively identified for inclusion into the study by reviewing patients who discharged by death from Seasons Hospice between July 1 2015 - June 30 2019. Each eligible patient was screened and ultimately admitted into the review if they have met the inclusion/exclusion criteria. Research investigator also obtained the previous inpatient hospitalization’s oral morphine equivalent (OME) and time exposure from MedStar Health electronic health record to help guide the analysis in determining the appropriate drug initiation or titration. A standardized algorithm was created and approved by research investigators prior to data collection. This study is IRB exempt. Results Baseline characteristics include hospice admission diagnosis (68%), male (52%), hospice setting of home (68%), and average age of 71. Only 5 patients (26%) of all methadone and TDF initiation/titration were done appropriately in our findings. Conclusions More than half of initiation or titration of the two high-risk opioids were deemed inappropriate by our criteria. TDF initiation made up the majority of inappropriate dose changes in patients who discharged on hospice. Medication changes made with palliative care pharmacist involvement were more likely to be appropriate.
