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The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act was signed into law by President Trump in October 2018. This legislation is aimed at addressing the opioid epidemic sweeping through the nation, with thousands of lives lost or ruined due to rampant abuse of prescription pain medications. In addition to making addiction treatment options more widely accessible to those who need it, this particular law brings a helpful change to those working in hospice and palliative care. Although the act was passed at the end of 2018, we continue to receive questions from those still uncertain about who can dispose of controlled substances as well as when and how they can do it.

In early 2019, the American Geriatrics Society (AGS) released an update to the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, otherwise referred to as the Beers Criteria. The Beers Criteria provides a framework for safe medication prescribing in older adults, based on an expert panel’s systematic review of available evidence surrounding drug-related problems and adverse events in patients 65 years and older. The panel evaluated over 1,400 publications that had been released since the last update in 2015 - including clinical studies, reviews and guidelines.

Our “Together as One” series spotlights nurses, physicians, pharmacists and others who positively impact the lives of hospice patients and their families every day. Through the dedicated and compassionate work of these inspiring professionals, patients receive the high-quality care and attentive consideration they deserve. Together with innovative and responsive hospice partners, they create the network of support so essential to hospice care. We invite you to meet the people behind the mission—and see what one can do.

Kim Johnson, RPh

Pharmacist-in-Charge

Las Vegas, NV

How did you become interested in pharmacy?

I became interested in pharmacy when back in the early 90’s I lost two jobs due to business closures and had the opportunity to go back to school. My counselor suggested I go into the health field. I had 3 small children and I knew our local pharmacist pretty well. She told me she loved her job and convinced me that it was a great field for a woman to get into because of the...

There is a need for alternative routes of administration in hospice and palliative care patients who often suffer from nausea and vomiting, dysphagia, gastrointestinal obstruction, and mental status changes, all of which may limit intake of oral medications.  Compared to common alternative routes such as the intravenous and intramuscular routes, the rectal route of administration has certain practical advantages, as it does not require extensive patient or caregiver education and can be administered in the comfort of one’s own home. In addition, it is generally less expensive when compared to topical, subcutaneous, or intravenous routes.¹

Our “Together as One” series spotlights nurses, physicians, pharmacists and others who positively impact the lives of hospice patients and their families every day. Through the dedicated and compassionate work of these inspiring professionals, patients receive the high-quality care and attentive consideration they deserve. Together with innovative and responsive hospice partners, they create the network of support so essential to hospice care. We invite you to meet the people behind the mission—and see what one can do.

Gary Henglefelt, BSPS

Vice President of Pharmacy Operations - Western Division

Tempe, AZ

How did you become interested in pharmacy?

Growing up on a farm in South Dakota provided a working relationship with the local pharmacy. Mostly for vet medications but it developed my interest as to the knowledge of a pharmacist and what help they provide.

What are your favorite aspects of your job?

Helping nurses and caregivers provide needed care to patients at the end of life.

Our “Together as One” series spotlights nurses, physicians, pharmacists and others who positively impact the lives of hospice patients and their families every day. Through the dedicated and compassionate work of these inspiring professionals, patients receive the high-quality care and attentive consideration they deserve. Together with innovative and responsive hospice partners, they create the network of support so essential to hospice care. We invite you to meet the people behind the mission—and see what one can do.

Shekar Ganesh, PharmD

Pharmacist and Assistant Manager

Morton Grove, IL

How did you become interested in pharmacy?

I enjoyed working as an inpatient hospital pharmacy technician prior to pharmacy school, which further sparked my curiosity in a career in pharmacy. Additionally, I enjoyed learning general chemistry and organic chemistry, both of which are important to understanding pharmacology.

What are your favorite aspects of your

 job?

Our “Together as One” series spotlights nurses, physicians, pharmacists and others who positively impact the lives of hospice patients and their families every day. Through the dedicated and compassionate work of these inspiring professionals, patients receive the high-quality care and attentive consideration they deserve. Together with innovative and responsive hospice partners, they create the network of support so essential to hospice care. We invite you to meet the people behind the mission—and see what one can do.

Kirk Davis, PharmD

Pharmacist-in-Charge

Vancouver, WA

How did you become interested in pharmacy?

I originally graduated in December 2008 with a BA in Economics. This was at the height of the Great Recession, limiting entry level career opportunities and causing me to reflect on the possibility of returning to school. I ultimately decided to pursue a doctor of pharmacy degree because the pharmacy field seemed stable and offered me a chance to study the hard sciences,...

Have you read the report from the Department of Health and Human Services? Medicare Part D reimbursements for hospices are likely to be scrutinized more carefully in the near future.

Diuretics can be especially useful to the hospice clinician for managing fluid retention or edema that commonly occurs in patients with heart failure, cirrhosis, and cancer. Unfortunately, long-term use of loop and thiazide diuretics can lead to hypokalemia, which can be particularly challenging to treat in patients with dysphagia given the fact that many potassium chloride (KCl) supplements are inherently large and difficult to swallow. It’s important to consider the potential alternatives for patients with dysphagia and the advantages and disadvantages of the various KCl formulations that are currently available: tablets, capsules, powder for solution, and oral solution (Table 1). When choosing a KCl product, the hospice team should consider special instructions for administration, palatability, risk for adverse effects, and contraindications of each.

With so many different probiotics on the market, it’s hard to know which ones to use and when to use them. They’re commonly promoted as agents to help strengthen the immune system or recolonize the GI tract with “good bacteria." Probiotics are found in foods, dietary supplements, infant formulas, and medical foods with strain compositions, doses, and storage requirements that vary widely among products. Since the evidence for various indications is formula-specific (genus, species, strain, number of live bacteria present, blend of probiotic strains, non-active ingredients) and the commercial availability is constantly changing it can be challenging to be sure you’re choosing the right probiotic for your patients, especially in a field that’s still evolving.