Proactive Prescribing Enhancing Hospice Care Through Anticipatory Pharmacy Practices

Abstract

Purpose: This project aims to reduce avoidable hospitalizations, alleviate caregiver stress, improve patient comfort during the end-of-life phase through assessing RN case manager confidence in educating families about anticipatory medications and rolling out the educational pamphlet as a teaching tool. Background: Hospice care prioritizes comfort and quality of life for individuals with terminal illnesses. However, inadequate symptom management, caregiver burden, and frequent hospitalizations remain persistent barriers to effective hospice delivery (Virdun et al., 2015; O’Hara et al., 2010). Delays in medication access often lead to distress, emergency interventions, and unplanned hospitalizations, which undermine the goals of hospice care. Anticipatory prescribing, a proactive approach that ensures symptom management medications are available at the start of care, has been associated with improved comfort and reduced crisis events (Au, Baker, & Hindmarsh, 2022; Charlesworth, 2020). Methods: The project was conducted at a local hospice in Tucson, Arizona. A multidisciplinary team reviewed current prescribing practices and developed an anticipatory pharmacy protocol that included a standard set of medications for common end-of-life symptoms such as pain, dyspnea, agitation, and nausea. Educational sessions were conducted for hospice staff and caregivers to support medication administration. Data on symptom control, hospitalization rates, and RN case manager comfort with anticipatory prescribing and caregiver education were collected and compared pre- and post-implementation. RN comfort was assessed using a structured survey tool designed to measure confidence in initiating and educating on comfort medications. Results: Seven hospice nurses completed pre- and post-intervention confidence surveys, with average confidence scores increasing from 1–2 (not at all/slightly confident) to 4–5 (confident/very confident), representing an approximate 70% improvement across all domains. Among 20 patients who received the standardized education pamphlet, 12 (60%) effectively utilized comfort medications, and none required hospitalization for uncontrolled symptoms within 30 days. In comparison, the retrospective control group (n=20) experienced 4 hospitalizations (20%), including 2 related to uncontrolled pain despite medication availability. Pharmacy costs decreased to 3.3% of direct costs, the lowest in six months, accompanied by fewer on-call visits and improved home symptom control. Conclusions: Integrating anticipatory prescribing into hospice admission protocols may significantly enhance the quality of end-of-life care. While the upfront cost of early medication delivery may increase, it is outweighed by reductions in crisis interventions and hospital-related expenditures. These findings support the need for broader adoption of anticipatory pharmacy practices across hospice settings to promote patient-centered, cost-effective care.