Hospice-Appropriate Universal Precautions for Opioid Safety

Catherine Covington-East, MA, RN, BSN, CHPN


Journal of Hospice and Palliative Nursing. 2017;19(3):256-260. 

In This Article


Opioid medications play important roles in managing comfort at the end of life. Hospice nurses depend on using these medications to help their patients achieve better quality of life and comfortable dying. Many hospice nurses are accustomed to working to allay their patients' fears of addiction and overcoming the stigma associated with use of these medications. Yet, the burgeoning epidemic of prescription drug abuse is a serious public health concern, and hospice clinicians must not ignore the potential for their patients' medications to be a source of harm to the larger community.

Research shows some support for using universal precautions in settings such as pain clinics and primary care practices but is lacking in hospice settings. The agency leadership considers the use of the universal precautions to be an improvement in practice, and so the program continues to be part of agency practice. The agency's written materials on medication safety and disposal, and the electronic documentation system, continue to be revised to support its use. Universal precautions designed for home hospice patients, which make use of the strengths of the hospice team and their relationships with patient and family as structured in the Duffy[19] Quality-Caring Model, streamline interventions in comparison with universal precautions designed for primary care practices or pain clinics, which include risk assessment, intervention algorithms, and urine screens. More research is clearly needed and should focus on measuring outcomes drawn from caring relationships central to hospice nursing.