Use of Tableau for visualizing caregivers' administration of comfort medications when managing hyperactive delirium during hospice patients' last week of life

Hyperactive delirium (HD) is an acute neuropsychiatric condition characterized by confusion, agitation, and restlessness, and it is commonly experienced by hospice patients near the EOL (end-of-life). While comfort medications including opioids, benzodiazepines, and antipsychotics are routinely used to manage delirium symptoms, some research suggests that they may paradoxically worsen HD. In home hospice settings, informal caregivers administer these medications, but are not required to document if and when they do; therefore, little is known about the pharmacologic management of HD in home settings. This pilot study used Tableau as a data visualization technique to explore the temporal relationship between HD episodes and comfort medication administrations during hospice patients' final week of life. A retrospective chart review was conducted using archival records of 19 home-hospice patients who experienced HD in their last week of life to determine all administrations of opiates, benzodiazepines, and antipsychotics administered during this same time period. Across the cohort, a total of 133 HD incidents occurred, and 1,847 medication administrations were documented for analysis. Data visualization illustrated variability in HD episodes across patients but revealed a trend of escalating episodes as death approached with a peak two days before death. Comfort medication administrations followed a similar trajectory, but with variations by regimen. Scheduled medications increased over time for all medication classes while PRN (as-needed) medications remained stable, suggesting a greater likelihood of comfort medications being administered when scheduled. This study presents a unique way of visualizing and examining medication use and HD at the EOL.