OKAY, here's the story. First let me say that I think Hospice is a wonderful benefit and have no problem calling them in for my residents who are appropriate.
That said...I have a resident who is 94 years old and at the end of her life. She was very agitated and having some respiratory distress so the Hospice nurse suggested Ativan and Roxanol as a standing dose and said the son wants her "well medicated". Yesterday, one of the nurses came to me and told me the woman's respiratory rate was 6. She was calm, and appeared to be in no pain and have no distress of any kind. She told me she wanted to hold the Roxanol and Ativan as the woman was barely responsive and in no apparent distress. I agreed with her and she held the meds. The woman continued in that state. The hospice nurse came in, looked at the records and started hollering about withholding pain medication from a patient who was going to die. I explained to her that we(who are there ALL the time, not 5 minutes out of the day) assessed the woman and found her to be neither agitated nor in pain or resp. distress. The hospice nurse started to tell me that the hospice philosophy is to medicate regardless with NO parameters and how dare we not give this woman her meds...so I said we would never give meds to someone who had a resp rate of 6 who was in no distress. She told me she was going to call the hospice medical director to see what he said.
The patient's nurse practitioner was there, assessed her and came to the same conclusion I did. The woman was in no distress. We have the med available and certainly if she needs it she'll get it.
Am I wrong? Do all y'all keep giving Morphine with a resp rate of 6 and no signs of distress? The last pain inservice I went to which, by the way, was given by a hospice nurse practitioner, said the standard of care would dictate that we write orders with parameters to hold morphine for a resp. rate of less than 8 unless the patient was exhibiting s/s of distress or pain.
Comments?
Nursing News