Date of Award

Spring 5-23-2015

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Mary Jo Clark, PhD, RN, Faculty Chairperson

Second Advisor

Jacqueline Copeland, DNP, MSN, APRN, FNP-C, Clinical Mentor


Purpose: The purpose of this project was to improve end-of-life pain management among hospice patients using a rectal medication administration device (RMAD).

Background: Approximately 1.5 to 1.6 million patients received hospice services in 2013 (National Hospice and Palliative Care Organization, 2013), and almost 75% of terminally ill patients experience pain during the dying process (Fink & Gates, 2010). Patients are often unable to tolerate oral pain medications at the end of life. Rectal administration of medication is an appropriate alternative for these patients. The rectal route has several benefits including low cost, consistent and predictable absorption of medications, ease of use, and good symptom management (Davis, Walsh, LeGrand, & Naughton, 2002).

Approach: End-of-life patients unable to tolerate oral pain medications are currently switched to a subcutaneous button route. These patients will be offered the RMAD as an alternative before the subcutaneous button is used. After consent is obtained for use, patients will have a trained licensed nurse place the device and sit bedside to administer the medications until the patient’s status changes. Pain levels will be monitored before and after medication administration using the FLACC scale.

Outcomes: A total of four patients over 3 months, 100% of the patients experienced a decrease in pain scores.

Conclusion: This program showed that a RMAD device is useful for pain medication administration and resulted in a decrease in pain levels in all four participants. Continuation of RMAD use would provide an alternate route of medication administration that is easy to use, efficient, and cost effective when oral medication administration is not appropriate.


Davis, M. P., Walsh, D., Legrand, S. B., & Naughton, M. (2002). Symptom control in cancer patients: The clinical pharmacology and therapeutic role of suppositories and rectal suspensions. Support Cancer Care, 10, 117-138. doi: 10.1007/s00520-001-0311-6

Fink, M.J., & Gates, R. A. (2010). Pain Assessment. In B. R. Ferrell & N. Coyle (Eds.), Oxford textbook of palliative nursing (pp. 137-160). New York, NY: Oxford University Press.

National Hospice and Palliative Care Organization. (2013). NHPCO’s facts and figures: Hospice care in America. Retrieved from