[AtlantaRN]

I am a full time hospice nurse, and we have a couple of prn nurses. Well, tonight I'm not on call...Marketing person calls to say there is an admission, 40 miles away...well I can't get there in 40 minutes, and the oncall person starts at 5pm, so I called her. She was MAD ...says "I'm at my last patients home and I can't possibly get there by 5pm. Marketer calls her and gives her the information---said nurse calls the family, arranges to be there at 6pm.......................Nurse on call just called at 6:45pm, said patient is there, according to staff DME was there before the patient arrived with trach oxygen...says "but the family isn't here, what do I do." I told her to call the family, and ask if you can come to their home to sign legals.....I truly don't know if she called because she told me "they said they would be at the NH tomorrow, have them sign them tomorrow." I asked "when did they say they will be there?" she said "they didn't say................" Wouldn't that be a good question to ask, or is it just me.

BTW: can we legally do a full assessment on a patient that technically isn't ours yet? She said she did a full assessment, but no consent for treatment has been signed.

Thoughts?

Thanks, i'm just irritated....

[Mandee]

No way can you do an assessment on a patient without signing consents first...and a 5pm admission would defintely be the on call nurse....at least I know it wouldn't be me if I worked all day.

[AtlantaRN]

The on call nurse just called me for like the 10th time...She had finally had a family member come back up to the NH to sign legals...She said the facility was upset that we hadn't provided all of the meds for the patient (apparently they have never had a hospice patient before). On call nurse said the admission orders were in the pack from the hospital, but they didn't send anything to our manager, or to the office before transferring the patient to the nursing home. So there the little elderly lady sits, no meds, no way to get meds this late at night (per the nursing home), as they expected us to swoop in with all the meds...........

Tomorrow the word of the day will be EDUCATION, both of the facility, and the hospital this patient was transferred from.

[Sabby_NC]

Tsk Tsk I agree with Mandee nothing should have been done nor should that patient be asssessed AT ALL until all the necessary paper work is filled in and signed.
On going education with facilities and hospitals is a must as I have found this out over and over again.
Our Hospice is having admission teams to work on an on call schedule too which will be such a bonus. We have 4 offices in our organization and have admission RN and SW in those areas to do all the admits.
Very rarely do we have to do them which is such a bonus. We can concentrate on our on case management.
Good luck on the education.

[Hospice Nurse LPN]

You shouldn't TOUCH a pt, let alone do a head to toe assessment without the consent forms being signed!

[aimeee]

If we have already spoken with the family and they are delayed in arrival and verbally agree to it, we will go ahead with the assessment but no further without signed papers. This sort of situation can arise and sometimes does no matter how well everyone is educated because you cannot control what the hospital, the nursing home and the families do, so what you need is a process and an agreement on the contingency plans ahead of time for what you will do when things go awry.

BTW, we would have gone out to a local pharmacy and bought what was essential for the night. If any were non-hospice covered I would work out a deduction from our bill from the facility for those since they stated they could not provide what the patient needed.

[EmptytheBoat]

Why the rush to judgement? Drive-by Hospice? Where's
is your coordinator/administrator? Is marketing dictating
nursing care? What pallative care can you provide with
this situation?