Special Populations – MAiD Flashcards
Provisions in Canada, 2019-2021
Provisions in Alberta
But if you just look at that. a violet colored bar across the middle, that is actually the overall percentage in Canada, and it’s around 3%.
if you look at Alberta
in our practice area, it’s actually a little bit below the average, and there’s 2 provinces that you hear about a lot that that made is provided more often, and those are Quebec and British Columbia.
So if you look at the number the actual number of made provisions per year in Alberta. They’ve been going up since it was introduced. and last year there were 836 provisions
This just tells me more and more of our colleagues and pharmacy are exposed to made practice; and and being asked if they would like to participate
MAiD by Age
Main Condition
Dispensing Location
In 2021 Alberta, medications were dispensed from a
* Hospital pharmacy 32.1%
* Community pharmacy 67.9%
the ages sort of span across adulthood to well into nineties, a lot of them in the 65 to 80 range.
and pretty pretty even numbers, male female.
The conditions most often associated with made request, so the main condition there could be. Many, of course.
are related to cancer.
This is again the Canadian data, and Alberta the second one is actually neurological conditions. But you can see there’s a bit of a drop off.
IV Protocol
Anxiolytic Opioid
(optional)
Local Anesthetic
Coma inducing
Neuromuscular Blocker
Midazolam 2.5 – 10 mg 2 min
Fentanyl 25 – 500 mcg 1-2 min
Lidocaine 40 mg 30 sec
Propofol 1g + 5 min
Rocuronium 200 mg rapid
between most of these medications with the administration there would be a sailing flush.
Sometimes there can be a drug interaction in the actual line, and there could be. You just want to flush it. So all the medication is through. So there’s no physical incompatibility.
You also want to make sure all the drug gets in the patient’s body.
These are timed, 2 mins is long, provider needs to hold syringe in line slowly
Order for keeping the pt comfortable
- Some of the medications are quite unpleasant
- Propfol burns so lidocaine is used for numbing the area
Detail and Variations
Pain or
dyspnea
Propofol is
painful
Clinician confirms
deep coma. If
any doubt,
administers
additional drug
Administers NMB
even if vital signs
absent
there’s instructions there that help decide what dose is best
I’ve just highlighted some reasons on the right hand as a slide. Why these drugs might be included.
Now the neuromuscular blocker is at the very end
Now the neuromuscular blocker is at the very, very end of the protocol, and sometimes the patient has already passed by the time that is given.
but it’s still given because it’s very important for the effects that it has.
IV Protocol
pros and cons
Advantages
* Prevents some
complications, e.g., due to
emesis
* No bioavailability issues
* Clinician is present to treat
side effects and
complications
Disadvantages
* Less patient autonomy
* Requires IV access: greater
intervention
* Clinician requires greater skill
for IV access and
administration of
medications
Oral Protocol
Gastric motility/
Antiemetic Anxiolytic Coma-inducing
Opioid
(optional)
18
Not used in Alberta
Haloperidol
2 mg
1 hour preingestion
Lorazepam
0.25 - 0.5 mg
DDMP2
1-2 minutes
DDMP2
Digoxin 50mg
Diazepam 1g
Morphine 15g
Propranolol 2g
In 100 – 125 mL water, juice or alcohol
Oral Protocol
pros and cons
Advantages
* Autonomy
* Less ‘medicalized’
* Not invasive, no IV etc.
* Administer at home or
favorite location
* Locus of control: Save
medication until ‘things get
really bad’
Disadvantages
* Requires ability to selfadminister
* Associated with
complications
* Nausea, vomiting, other
* May not be able to
administer, if delays
* May require clinician
presence, IV back up
Symptom Management
Emesis
* Respiratory
secretions
* Seizures
* Pain or distress
Thinking
differently
about
medications
and how
they are
used
- Toxicology studies are dedicated to
preventing lethal exposures - Clinical trials are designed to optimize
benefit and minimize risk - Evidence is low re: medication used in
MAiD provision (observational, expert
opinion)
Research:
Medications
used in
MAiD
- Study: Impact of medications on time
until death and complication rates - Retrospective cohort study (Ontario, BC)
- Results
- 3557 patients, mean age 74 y, 70.8%
cancer diagnosis - Variations in protocol
- Median time 9 minutes, range 1-127
minutes - Complications (1.2%), mainly due to
- Venous access
- Need for administration of a second
medication - Value in standardizing the protocol
(knowing what to expect) - Educate patients and their families about
medications and what to expect
Legal Perspective
- Federal Legislation
- Policies and Procedures in Alberta
MAiD Process
- Patient’s request
- Patient assessment (2)
- Eligibility
- Provision
- Planning
- Schedule day - Procedure Verification
- Schedule day - Administration of Medication
Pharmacy Practice Perspective
- Medication Supply
- Reviewing the prescription/order
- Checking medications/kit
- Provide back-up kit, PRN
- Return medications/kit
- Teamwork
- Coordinating team, Navigator
- Meet with provider, MD or NP
- Share information
- Ensure process is followed
- Debrief provision/experience
- Documentation
- Complete Pharmacist section of the Providing Practitioner
Record for MAID - Submit required reports
HOSPITAL PHARM EXPERIENCES W maid: QUALITATIVE STUDY
Results
* Each participant experienced MAiD practice in a unique way.
* They viewed MAiD and their role in relation to themselves,
the patients, the pharmacy and health care teams, and their
family, friends, and community
* Roles in MAiD were primarily medication-focused, yet
experienced as a caring role
* Experiences with MAiD a involved a range of emotions
