Can Palliative Medications be Utilized Outside of the Special Project?

Is it permissible to administer palliative care medications, as outlined in the directive, to patients who are clinically appropriate for such treatment but are not enrolled in a palliative care program, following consultation with a Base Hospital Physician (BHP)? For example, administering hydromorphone for cancer-related pain in a patient currently prescribed this medication, or using haloperidol for delirium, agitation, behavioral issues, or as an antiemetic.

The use of palliative care medications, such as hydromorphone for cancer-related pain or haloperidol for delirium and agitation, is typically reserved for patients who are registered in a palliative care program. However, in situations where a patient is clinically appropriate for palliative care interventions but is not officially enrolled in a palliative care program, paramedics are advised to consult with a Base Hospital Physician (BHP) for direction.

For instance, if a patient with a confirmed cancer diagnosis is experiencing uncontrolled pain and is currently prescribed hydromorphone, it may be appropriate to continue this medication to align with their established care plan. In such cases, after consulting with a BHP, administering hydromorphone could be considered to maintain continuity of care.

Conversely, for patients who are not on a regular opioid regimen or are awaiting a diagnosis, alternative pain management strategies should be considered. For example, administering fentanyl under the pain management directive might be more appropriate in these situations.

It's crucial to engage in discussions with the patient and their family about the potential risks and benefits of using palliative care medications, ensuring they are comfortable with the proposed interventions. The current guidelines do not support the use of palliative care medications for patients without palliative conditions. For patients with acute pathologies, existing medical directives provide the best practices and frontline treatments.

In summary, while there is some flexibility in administering palliative care medications to patients not formally registered in a palliative care program, such decisions should be made cautiously. Paramedics should always consult with a BHP to ensure that the treatment aligns with the patient's clinical condition and established care plans.