Out of Scope of Practice???? - page 2

by ladytopaz

5,232 Views | 30 Comments

Yesterday several family members came in to see their loved one stating that they had heard through other family members that they were now being seen by Hospice. To make a long story short, the day nurse had spoken with a family... Read More


  1. 1
    Quote from CapeCodMermaid
    I don't where all y'all work, but where I've worked 99% of the time it's the NURSE who brings up hospice. We are the ones who know the resident and the family. It is NOT outside the scope of anyone's practice to advocate for the resident.
    You took the words right out of my mouth. I also agree with what Brandon said.
    Sun0408 likes this.
  2. 0
    One question. Doesn't the actual consult to a hospice provider have to be an official order from the physician?
  3. 0
    Yes it needs to be an order, but a T.O. is okay.
  4. 0
    Quote from artsmom
    Yes it needs to be an order, but a T.O. is okay.
    So a nurse (even a RN) can't just deciede to call the hospice company for a consult for a resident. It has to be physician ordered, right?
  5. 0
    Yes, technically.
  6. 5
    Quote from artsmom
    Yes, technically.
    Just to talk to a hospice representative does NOT require a MD order. (The point of this conversation is a Q & A about what hospice care is all about, the services to be provided, financial information, etc) To have the hospice actually begin services requires an MD order.
    KelRN215, ~*Stargazer*~, nrsang97, and 2 others like this.
  7. 0
    We require an order for the initial eval.
  8. 0
    Yeah, I think we do too. You need an order to consult a hospice service, just like you need an order to consult a specialist.
  9. 2
    Quote from artsmom
    We require an order for the initial eval.
    Yes, an eval requires an order. During an eval there will be resident specific concerns discussed, ie: what meds they are on, what end of life diagnosis will be used, contract agreements signed, the nurse will do a hands on clinical assessment of the resident.

    During a talk with a hospice representative (that does not require an order) - this is simply a discussion by a hospice representative related to the services they provide. This is no different than any person that wanders into your facility and requests a tour and a little information. Nothing more than a fact gathering session and not an agreement to any services. My local hospice services are always more than happy to come out and give their talk. There is no commitment for services to be provided. The family has the option of agree to an eval or decline the use of hospice care. If they want an eval then I call and get the order. Hospice will not go any further in the process until there is a MD order on the chart. This allows the family or resident to be fully informed of their options before an agreement is made.
    NutmeggeRN and wooh like this.
  10. 2
    Thanks for the great discussion, you three! I learned a lot by your conversation.
    Altra and tigerlogic like this.


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