Haldol Use Among Hospice Patients Being Cared For In Community-Run Homes

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.