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Pseudobulbar affect (PBA), also called emotional lability, is a condition of uncontrollable laughing or crying without provocation that isn’t consistent with a patient’s emotional state. PBA is most often observed in patients with neurological disorders such as amyotrophic lateral sclerosis (ALS), multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, brain tumors, or as a sequela of stroke. The management of this condition includes an FDA-approved drug combo of dextromethorphan and quinidine, or Nuedexta®, which has also been used off-label for controlling agitation or aggression in Alzheimer’s dementia patients. Nuedexta® comes with a hefty price tag (AWP is $26.70 per dose) and is only available as an oral capsule, presenting potential barriers to use in hospice given capitated reimbursement rates and drug administration challenges in patients with dysphagia.

Since treatment with Nuedexta® may be cost-prohibitive and dextromethorphan (DM) is readily available as an...

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.

Achille Tiam, PharmD

Pharmacist

Las Vegas, NV

How did you become interested in pharmacy?

My interest in pharmacy came from several conversations with my brother, who is also my mentor and a pharmacist. Before going into pharmacy, I was a teacher and kept bragging to my brother that I am a key element in society because I have an impact in each of my student’s lives. In response to my self-important speech, my brother stated that he has the opportunity to not only...

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.

Ryan Volkman

Service Delivery Director

Tempe, AZ

What is your role with OnePoint Patient Care?

I've been with OnePoint for the past 14 years, and am currently the Service Delivery Director to Arizona hospices.

What inspired you to pursue a career in Health-Care?

My first exposure to the health care field was from my mom working as a Respiratory Therapist for home care and in the hospital. 

Neuropathic pain is pain caused by a lesion or disease of the somatosensory system¹ and is often described as sensations of burning, tingling, shooting, sharpness, stabbing, or like electrical shocks. It is associated with conditions seen in many hospice patients including cancer, diabetes, and stroke. Neuropathic pain may also be a complication of neuromuscular diseases (like ALS or multiple sclerosis) or nerve injury that may occur following trauma, surgery, or infection (e.g. shingles). Sometimes the cause may be unknown, but what’s clear is that neuropathic pain can be a significant source of discomfort and debility.

When patients transition to hospice, deprescribing can be used as a tool to align treatment plans with changing goals of care. Deprescribing is the process of discontinuing inappropriate, ineffective, or unnecessary medications and is often used in an attempt to manage polypharmacy and improve patient outcomes.¹ Medications used to treat hypertension (collectively referred to as antihypertensives) should be among those medications considered for deprescribing if they’re ineffective for palliating symptoms or improving quality of life, especially in older patients who are often more susceptible to medication adverse effects (including dizziness and hypotension leading to falls).

During these unprecedented times, our partners and patients collectively depend on our continued service more than ever. All of us in the healthcare community are figuring out safe, effective ways to operate, support our patients and provide seamless care to those who rely on us most. 

As a pharmacy provider committed to serving the hospice industry, OnePoint Patient Care has a responsibility and commitment to safeguard our hospice partners, your personnel, your patients and their families from Coronavirus Disease 2019 (COVID-19).

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...