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Pain and palliative care 

Pain and palliative care is a new and emerging PGY2 program. The purpose of this specialty residency is to provide in-depth experience in the management of chronic non-malignant pain, end-of-life care, and malignant pain. Pharmacists completing this residency will be an integral part of an interdisciplinary team that provides pharmacologic and non-pharmacologic approaches to pain management.

Palliative care: what is it and who is it for?

The pharmacist's responsibilities

  • Pharmacists maintain patient medication profiles and monitor all prescription and non prescription medication use for safety effectiveness. Phamacists provide patients with essential medications within a timeframe that ensures continuous symptom control (especially pain relief) and avoids the need for emergency medical services.


  • Pharmacists attend hospice team metings to advise other team members about medication therapy, including dosage forms, routes of administration, costs and availability of various drug products. This is done through regularly scheduled educational sessions. Pharmacists develop and maintain a library of contemporary references about medications, dietary supplements, and alternative and complementary therapies. Pharmacists advise members of the hospice team about the potential for toxicity from and interactions with dietary supplements and alternative and complementary therapies.


  • Pharmacists ensure that all medication labeling is complete and understandable by patients and their caregivers. Hospice pharmacists communicate with patients, either through the team or in person, about the importance of adhering to the prescribed drug regimen. Pharmacists explain the differences among addiction, dependence, and tolerance and dispel patient and caregiver misconceptions about addiction to opiate agonists. Pharmacists ensure the availability of devices and equipment to permit accurate measurement of liquid dosage forms by patients and their caregivers. Pharmacists counsel patients about the role and potential toxicity of alternative and complementary therapies. When needed, hospice pharmacists visit patients’ homes to communicate directly with patients and their caregivers and to make necessary assessments.


  • Hospice pharmacists communicate with pharmaceutical manufacturers to determine the availability of nonstandard dosage forms. Medication-compounding needs in hospice care include the preparation of dosage forms to ease administration (e.g., concentrated sublingual solutions, topical medications), flavoring medications to promote compliance, eliminating or adjusting ingredients that patients cannot tolerate, and preparing or changing drug concentrations. Whenever possible, pharmacists compound formulations for which stability and bioavailability data are available.


  • Hospice benefits usually cover medications. However, patients may lack insurance coverage or benefits may not cover medications that are not considered strictly palliative. Pharmacists communicate with pharmaceutical manufacturers to obtain medications through patient assistance programs.


  • Medications dispensed to patients are “owned” by the patients and, in most states, cannot be used for other patients. Medications remaining in patients’ homes fall under a variety of hazard categories. Pharmacists are able to assist families with the removal of the medications from the home in compliance with federal and state drug control and environmental protection laws and regulations.


  • Because hospice patients often require large quantities of controlled substances, open communication with both state and federal controlled-substance agencies is important. Pharmacists ensure compliance with laws and regulations pertaining to medications.


Source: ASHP statement on the pharmacist's role in hospice and palliative care. Medication Therapy and Patient Care: Specific Practice Areas-Statements (p. 299-302)

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