Home Run: How Lessons Learned Using Dexmedetomidine in the Inpatient Hospice Unit Allowed for its Use in Home Hospice

Key Message: Dexmedetomidine is a versatile drug that has established itself as a critical medication in intensive care units, and more recently, in our 30-bed inpatient hospice unit. Given its unique properties, it can also be a valuable tool to care for patients with refractory symptoms in the home hospice setting.

Abstract: Dexmedetomidine is an alpha-2 agonist most often used in intensive care units as a sedative. In 2024, we began using dexmedetomidine infusions in our 30-bed inpatient hospice unit (IPU) in order to expand our arsenal of parenteral medications. The introduction of dexmedetomidine allowed for more nuanced management of pain, restlessness and agitation and also proved to be more cost-effective than our previous management of severe symptoms.

We previously described the implementation of our dexmedetomidine protocol, highlighting trends that informed our management. With another year of data, we will examine additional trends, discuss our current protocol, and explore additional insights on dexmedetomidine use in the unique setting of an inpatient hospice unit.

With increased success in managing symptoms with dexmedetomidine in our inpatient hospice population, we considered whether it could be used at home for patients with refractory symptoms and a longer life expectancy. We will explore the case of a 56-year-old woman with metastatic thyroid cancer and refractory pain who had been frequently admitted to our IPU for pain control. Given her goal to remain at home and her inadequate pain control, her clinical team, with involvement of key stakeholders including hospice physicians, nursing leadership, education team members, and pharmacists, created a new policy for dexmedetomidine use at home. We will discuss the process for creating a policy for home use and discuss indications for dexmedetomidine in the home setting using a case-based approach.

Conclusions:
Though dexmedetomidine is typically used for short-term sedation, we previously found it to be a valuable tool in the IPU setting for the management of agitation, restlessness, and pain. Given its unique properties and its effectiveness, we have expanded our indications to include home hospice patients with refractory symptoms to allow for greater symptom control and to reduce IPU re-admissions.

References: 1. Mupamombe CT, Luczkiewicz D, Kerr C. Dexmedetomidine as an Option for Opioid Refractory Pain in the Hospice Setting. J Palliat Med. 2019 Nov;22(11):1478-1481. doi: 10.1089/jpm.2019.0035. Epub 2019 Jun 13. PMID: 31194614.

2. Tavares T, Almeida J, Gonçalves E, Abelha F. Dexmedetomidine in Palliative Care: A Versatile New Weapon Against Delirium and Pain-Systematic Review. J Palliat Med. 2024 Oct;27(10):1390-1403. doi: 10.1089/jpm.2023.0609. Epub 2024 May 21. PMID: 38770684.