Serving Skagit, Island, San Juan, and Snohomish Counties

Palliative Pearls

A Moment for Reflection

All of us have special people in our lives who have loved us into being.  Take just 10 seconds to think about all of the people who have helped you become who you are, those who cared about you and w...

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What Care Would I Want if I Develop Dementia?

There are now advance directives designed to change as dementia progresses and goals of medical care change. A simple version that provides good overall guidance is available as a free download from w...

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NO CODE not necessary!

DNAR is NOT a prerequisite to hospice admission. Most patients admitted to hospice as “Full Code” transition to “Do Not Attempt Resuscitation” while receiving hospice care.  Patients begi...

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How Long Has She Got, Doc?

Helping families understand a timeline for elders with dementia can relieve suffering and help with planning. Dementia Mitchell Mortality Risk Index Score Points/Risk factor 1.9 Complete dependence wi...

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Beware of the F word – “Futility”

We find “Futility” is not a useful term when discussing treatment options. It is not well defined and tends to be inflammatory. It can mask value judgments by clinicians It can pit clinicians agai...

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Isopropyl Alcohol for Nausea

Another new study showed inhaled isopropyl alcohol significantly reduced nausea, this time in patients in the ED. Several studies have shown inhaled isopropyl alcohol can provide rapid relief of nause...

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Do-It-Yourself Palliative Care Consult – Part 2

When you would not be surprised if your patient died in the next year, it is time to take action to provide care that makes medical sense and is aligned with realistic patient goals. Try to improve pr...

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The Do-It-Yourself Palliative Care Consult – Part 1

Many patients in your practice may be interested in a palliative approach to care. Patients living with serious or life-threatening illness may be more interested in quality of life than quantity of l...

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Moral Distress

That pit in your stomach means you need to talk to a team member or colleague about a patient’s care. Moral distress occurs when you think you know the right thing to do, but you feel constrained fr...

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Routine Opioids at End-of-Life

Many dying patients are unable to ask for comfort medicines. More patients are dying in senior facilities without 24 hour staff able to assess nonverbal pain and dyspnea or use “as needed” medicat...

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