Informal Caregivers' Administration of Concentrated Liquid Morphine to Hospice Patients Receiving Home Care: Does Regimen Matter?

Background: Hospice patients receiving care at home rely on caregivers to manage liquid morphine for pain and dyspnea during the dying process. Medication is prescribed under varying regimens, yet caregivers are not required to record when morphine is used. Therefore, it is not known whether morphine use varies by regimen for hospice patients dying at home. Design and methods: A retrospective review of medication records from 227 deceased hospice patients who received routine home care in a residential setting in the U.S. Concentrated liquid morphine doses prescribed by hospice and doses administered by caregivers were calculated 7 days prior to death and on the day of death. Percent of maximum dose prescribed was determined by regimen type (scheduled, pro re nata, or combination) and by prescription flexibility (varied vs set doses/times). Results: Morphine was prescribed to 60.4% of patients a week prior to death and to 86.8% of patients on the day they died. Doses prescribed and percent morphine administered increased over the last week (P < .05), but percent of morphine administered was low 1 week prior to death (23.40%) and on the day of death (30.68%). On patients' day of death, nearly half (48.6%) of prescriptions included flexibility, and administration rates were lower (P < .01) with flexible prescriptions (21.84%) than with structured regimens (39.52%). Conclusion: Morphine was frequently prescribed in the last week of life, but administration rates by caregivers were low, especially with less structured regimens. Caregivers may need more guidance regarding morphine's use at home, especially with more flexible regimens.