“ … arts in 1803. In January, 1869, he was married to Cornelia Sherman, daughter and only child of Isaac Sherman, … Aetna Fire Insurance Company of New York. He married Miss Nellie Sherman, daughter of Isaac Sherman, Esq.,, a New York merchant … ”
Most individuals at the end of life express an interest in remaining at home, and home deaths are trending upwards in the United States. While home deaths may be desirable, there are a number of complex symptoms such as delirium, agitation, and nausea that can occur as individuals approach death. Hospice can prescribe medications such as Haldol to manage these symptoms, but oftentimes the responsibility of determining how and when to administer medications falls on family members. This study set out to examine how often informal caregivers are expected to make decisions about Haldol administration by examining the records of 317 hospice patients (188 women, 129 men) who died at one of 2 residential homes for the dying in upstate New York. In these settings, volunteers serve as surrogate family members and administer hospice-prescribed medications, and records are kept documenting when Haldol was given, how much was given, and what the maximum dosage allowed was. To assess Haldol prescription practices and utilization, both PRN (as needed) and scheduled doses of drug prescribed and administered were recorded for the first 24 hours at the care home and on the day of each patient's death. Results revealed that Haldol prescriptions were common, with 98 patients (30.9%) being prescribed the drug at some point while at a care home. Of these patients, thirty seven (37.8%) were prescribed Haldol as a PRN medication. Analyses of changes in drug use revealed that there was a significant increase in the average maximum total dose allowed in the first 24 hours (3.42mg) and the last 24 hours (5.67mg) (t(82)=-3.37, p=0.001) as well as in the average amount of Haldol administered from the first day of care (.78mg) to the day (2.69mg) patients died (t(82)=-3.75, p < 0.001). The results show that caregivers are frequently asked to make decisions on whether to use Haldol to manage terminal delirium. These findings suggest that family members caring for dying individuals at home may benefit from additional support.
“ … 8 The concept of rationalization originates from Max Weber (1905) and involves the process where modern … ”
Abstract
The COVID-19 pandemic greatly altered the work-lives of physicians, yet research has failed to describe how it has affected burnout in U.S. primary care physicians. In this thesis, I study burnout prevalence and contributing factors in U.S. primary care physicians during the COVID-19 pandemic. I performed a systematic review of research on primary care physician burnout and the COVID-19 pandemic, then cross-referenced this review with qualitative interviews of primary care physicians. Burnout was found to be in high prevalence in two of its three dimensions, emotional exhaustion and depersonalization. Main sources of emotional exhaustion included a changing work environment, increased workload, inefficiencies of telehealth, worse patient prognosis due to delayed care, and pandemic-related costs. Main sources of depersonalization included telehealth’s effects on workflow and ability to provide quality care to patients. Lack of personal achievement was worsened in some instances due to telehealth hindering the delivery of quality care, but in most instances, it improved due to increased feelings of purpose, pride, and camaraderie. Qualitative interviews echoed similar themes of increased emotional exhaustion and depersonalization, yet improved feelings of personal achievement. Recommendations include giving physicians more control over telehealth in their workflow and increasing access to healthy coping mechanisms. Targeting areas that induce the most significant stress and frustration can most effectively prevent and manage burnout in these physicians during the COVID-19 pandemic.
“ … Community-Run Homes Max Sherman Union College - Schenectady, NY Follow this and … Recommended Citation Recommended Citation Sherman,Max , "Haldol Use Among Home Hospice Patients Being … ”
Abstract
At the end of life, most individuals express an interest in remaining at home and home
deaths are trending upwards in the United States. While this may be desirable, there are numerous complex symptoms such as delirium, agitation, and nausea that can occur as death approaches. Hospice prescribes medications such as haloperidol (Haldol), but oftentimes, the responsibility of administering medications falls on family members. Managing medications can be complicated by side effects, polypharmacy, caregiver characteristics, and inconsistent professional support. This study set out to examine how often informal caregivers make Haldol administration decisions by examining the records of 317 hospice patients (188 women, 129 men) who died at one of two community care homes. To assess prescription practices and drug use, PRN and scheduled doses of Haldol prescribed and administered were recorded for the first and last 24 hours at the care home. Haldol prescriptions were common; 98 patients (30.9%) were prescribed the drug at some point. Analyses of changes in drug use showed a significant increase in the average maximum total dose allowed in the first 24 hours (3.42mg) and the last 24 hours (5.67mg) (t(82)=-3.37, p=0.001) as well as in the average amount of Haldol administered from the first day of care (0.78mg) to the day patients died (2.69mg)(t(82)=-3.75, p < 0.001). These findings show that caregivers of dying individuals at home may require additional support.
