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Description

In the setting of palliative medicine, the control of agitation, anxiety, and pain are essential to improving patients' symptomatology and quality of life. Dexmedetomidine, or Precedex, is an anesthetic agent that has recently been used more frequently for uncontrolled agitation, anxiety, or pain in palliative patients. While Precedex is shown to have clinical utility in the palliative setting, many palliative providers and nursing staff are unfamiliar with the dosing guidelines for this medication in the setting of palliative medicine, as the established dosing guidelines were created for its use in procedural settings for anesthesia. The aim of our quality initiative was to establish an institutional clinical guideline for Precedex use in inpatient palliative medicine at Corewell Health West.

We met with the inpatient and outpatient pharmacy teams, palliative medicine providers, and nursing leadership to establish the current institutional practices and knowledge surrounding the use of Precedex for palliative medicine patients. We performed a literature search of Pubmed, utilizing the search terms "(Palliative) and (Dexmedetomidine or Precedex)" over the past 5 years. We excluded results related to pediatrics, anesthesia, critical care, and procedural sedation.

Based on our meetings with nursing leadership and palliative medicine providers, we discovered that providers and staff felt they had limited comfortability with administering Precedex for palliative medicine patients. Based on our meetings with palliative pharmacy teams, we discovered that there is not currently an order set for Precedex in the setting of comfort care. We utilized a broad review of the literature to create a clinical guideline for Precedex administration in the setting of comfort care. This protocol encompasses Precedex mechanism of action, clinical utility, side effects, and dosing guidelines for different routes of administration.

Patient comfort is a mainstay of palliative medicine. Recently, Precedex has been used increasingly often to provide sedation in the setting of comfort care. Our initiative established a clinical guideline for Precedex use in the setting of inpatient palliative medicine at Corewell Health West. Based on our quality initiative, our next steps will be to distribute the clinical guideline and seek feedback on its clinical utility in inpatient palliative medicine.

Publication Date

5-8-2026

Disciplines

Other Medicine and Health Sciences

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1916

Guideline for Precedex Use in Comfort Care Settings at Corewell Health West: A Quality Initiative

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