ORIGINAL ARTICLE   Open access

Italian Journal of Emergency Medicine 2022 April;11(1):15-8

DOI: 10.23736/S2532-1285.22.00128-8

Copyright © 2022 THE AUTHORS

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language: English

Increase in use of morphine and midazolam when applying law N. 218/2017 in end-of-life patients admitted to an Italian High Dependency Unit

Attilio ALLIONE ¹, Jacopo D. GIAMELLO ² ✉, Remo MELCHIO ³, Francesco TOSELLO ¹, Daniela CARUSO ¹, Bartolomeo LORENZATI ¹, Giuseppe LAURIA ¹

¹ Department of Emergency Medicine, Santa Croce e Carle Hospital, Cuneo, Italy; ² School of Emergency Medicine, University of Turin, Turin, Italy; ³ Department of Internal Medicine, Santa Croce e Carle Hospital, Cuneo, Italy

BACKGROUND: On December 14, 2017, the Italian parliament approved law N. 219/2017, which contains new regulations about advance directives, informed consent, and shared care planning. One of the most relevant parts of the law states that “communication time constitutes treatment time.” This study aimed to understand whether the communication about end-of-life and its formal recording is associated with more careful palliative management and symptom control during the end-of-life care in the HDU setting.
METHODS: In this retrospective observational study we evaluated medical records of patients who died after the beginning of palliative care in a High Dependency Unit, in order to assess whether communication with the patient and family members and its formally recording were associated with changes in end-of-life drug use and symptom control.
RESULTS: One hundred eighty-eight patients were included. Patients for whom the palliative path was better defined and formally recorded presented lesser anxiety, more hydration, and greater use of morphine and midazolam in the last 72 hours of their life.
CONCLUSIONS: This is the first report about the effectiveness of law N. 219/2017 in improving the clinical-pharmacological management of dying patients in a High Dependency Unit. We observed a significant increase in better symptoms control and appropriate drugs treatment in patients in which communication time was spent and specified in medical records.

KEY WORDS: Ethics; Emergency service, hospital; Midazolam; Morphine