Medication issue

Parkerone · Aug 25, 2012

I have had a couple of experiences with hospice patients. One experience was with my mother in law. I had to manage the whole end of life episode with her. Bottom line is that THE MOST IMPORTANT aspect is COMFORT. A nurse needs to know that the management of pain and anxiety are very closely related. The patient knows they are going to die, the family know it also. It is a very frightening awareness for both. Not to be rude or condescending, but that is why the patient is on hospice care, end of life care. Depending on how close they are to dying is how close the meds are going to be given. Family members are more acute at knowing the the more familiar grimacing a patient may do and subsequently may push for more meds, even if the patient does not or is not able to respond. There should be a hospice nurse supervisor that you can bounce questions off of. They were very helpful with my situation and knew that I was a nurse.

It depends on how aggressive the family/patient desires are for the situation. In my mother in law's case it was very clear in her written wishes what she wanted. She wanted to go quickly and pain free. So we monitored the morphine (respirations) and her anxiety. If she became conscious of what was going on she became fearful, verbal and restless, so up went the morphine and up went the Ativan until you could see on her face that she was peaceful and in comfort, not thrashing around. The hospice super and the nurses there were very helpful. We ended up transferring her home from the hospital and that is where she "blasted off".

In retrospect, you may want to get a hold of a morphine and Ativan protocol and review it or have someone else review it with you. Also the chart should explain the patient's wishes. Hospice care involves a different use of medication as opposed to what we are taught in school.

Good luck I hope this was helpful.

beeker · Aug 25, 2012

I have had a couple of experiences with hospice patients. One experience was with my mother in law. I had to manage the whole end of life episode with her. Bottom line is that THE MOST IMPORTANT aspect is COMFORT. A nurse needs to know that the management of pain and anxiety are very closely related. The patient knows they are going to die, the family know it also. It is a very frightening awareness for both. Not to be rude or condescending, but that is why the patient is on hospice care, end of life care. Depending on how close they are to dying is how close the meds are going to be given. Family members are more acute at knowing the the more familiar grimacing a patient may do and subsequently may push for more meds, even if the patient does not or is not able to respond. There should be a hospice nurse supervisor that you can bounce questions off of. They were very helpful with my situation and knew that I was a nurse.
It depends on how aggressive the family/patient desires are for the situation. In my mother in law's case it was very clear in her written wishes what she wanted. She wanted to go quickly and pain free. So we monitored the morphine (respirations) and her anxiety. If she became conscious of what was going on she became fearful, verbal and restless, so up went the morphine and up went the Ativan until you could see on her face that she was peaceful and in comfort, not thrashing around. The hospice super and the nurses there were very helpful. We ended up transferring her home from the hospital and that is where she "blasted off".
In retrospect, you may want to get a hold of a morphine and Ativan protocol and review it or have someone else review it with you. Also the chart should explain the patient's wishes. Hospice care involves a different use of medication as opposed to what we are taught in school.
Good luck I hope this was helpful.

But a nurse still has to use their judgement. She gave the pain medicine, she just checked on the order and if it was ok to give it first. She did not withold meds, and let's be honest a lot of times families want things and do not have the training to know if they can all be combined. The nurse does, and I think checking on the order to see if it was ok was an ok thing to do. Maybe someone with more experience would have just given it quicker, maybe not. If the prn is q4 and the scheduled is q4 and coming up due along with anxiety meds, I think it is reasonable to not want to give it all as a big cocktail. When the patient stops breathing due to too much med, you bet the family is going to blame the nurse whether the patient is dying or not. It is the nurses job to do her due diligence and ensure safe administration, which she did do.