Reply To: End-of-Life Pain Management on Inpatient Hem/Onc Unit

  • Deborah Lafond

    February 27, 2019 at 10:30 am

    So glad you are being proactive in managing EOL pain and other symptoms on the floor!  It has made a world of difference for our patients and their families to be with the staff that know them so well and in an environment that has supported them.


    We are able to do all opioid PCAs and drips on the floor.  We also are able to do Dexmedetomidine, Ketamine, and Versed drips on the floor as well.  We do require an allow natural death/DNR order for EOL care.  Other uses for sedation meds have to be done in the PICU.  Opioid PCAs and NCAs can be done on the floor regardless of code status. 


    We collaborated closely with our Anesthesia Pain Team on the policies and procedures for this. The palliative care team manages them for EOL patients, but Anesthesia Pain Service manages them for all other patients.  We also had to petition our state Board of Nursing to be able to do them on the floor.  I am not sure what the Florida regulations are though.


    Good luck!  It is so worth the administrative hassle.


    Thanks,   Debbie


    Deborah A. Lafond, DNP, PPCNP-BC, CPON, CHPPN

    Clinical Director, PANDA Palliative Care Team

    Division of Hospitalist Medicine

    Children’s National Health System

    111 Michigan Avenue, NW

    Washington, DC 20010-2970

    PANDA Voice Mail: (202) 476-4256

    Office:  (202) 476-2194

    Fax:  (202) 476-6105



    We stand for children.


    ——Original Message——

    ​Hello All,

    We are finally moving toward offering our end-of life patients better pain management on our inpatient unit instead of having that mandatory move to the PICU! My questions to you are the following:

    1. What are you able to use on your floor? Lidocaine, Versed, Kettemine?
    2. What monitoring practices do you have in place?
    3. Did you find any hesitation from your inpatient staff? Do you have a “core” group who care for these patients?
    3. Would anyone be willing to share your policy/clinical standard?

    I would appreciate any guidance or words of wisdom that you are able to offer.

    Thanks and have a wonderful day,

    Kimberly Minus, RN, BSN, CPON, CPN
    Education Specialist
    St. Joseph’s Children’s Hospital
    Tampa, FL