Roxanol Prescription and Administration Practices in a Hospice Homecare Setting

Roxanol is a common hospice pain medication that can be prescribed under different regimens with varying doses and schedules.  In home care settings, caregivers are not required to record when medication is administered to patients; therefore, little is known about home hospice-prescribed Roxanol regimens and whether specific prescribing practices are associated with actual administration of medication during patients’ final days of life.  A retrospective review of patient care records of 227 deceased hospice patients who received routine home care between 2007 and 2020 was conducted. The overall amount of Roxanol administered to patients was examined by determining the doses prescribed as well as actual doses administered seven days prior to death and on the day of death.  In addition, the extent to which Roxanol was administered based on prescribed regimen (i.e. scheduled, PRN, or combined scheduled plus PRN) and whether prescriptions were written with flexibility (i.e. varied doses, varied times, or varied doses and times) was also examined at both time points. Roxanol was prescribed to a large percentage (60.4%) of patients a week prior to death with even more (86.80%) on the day of death. The dose prescribed and the overall percentage of medication administered increased significantly during the last week of life; however, the overall quantity of Roxanol administered to patients remained relatively low seven days before death (23.40%) and on the day of death (30.68%). The most prevalent regimen prescribed shifted during the last week of life from PRN only (54.79%) to combined PRN/scheduled (57.14%) on the day of death.  Nearly half of all prescriptions written contained some variability seven days before death (49.32%) and on the day of death (48.57%), and there was a greater likelihood that prescriptions were written with flexible dosing as opposed to varied time intervals. Administration rates were highest when prescriptions were more structured and did not vary by time or dose. The low overall Roxanol administration rates observed in this study suggest that certain regimens may not result in desired medication usage and that caregivers may need more clarity and guidance regarding when, how often, and how much Roxanol to administer.