Home health hospice position help

  1. i have applied for this job. it is a 30 minute drive during good traffic. they said i would get 4-5 patients a day and that it is 8-5 mon-fri and that we are paid hourly. the area is kind of spread out in that town but she said i would get the southern part which is closer to where i live. i think i would love hospice nursing. i am just wondering what i should be looking for with a home health hospice position. i know this sounds weird too but i was thinking a lot of these people must be on some heavy narcotics..how do you give narcotics at home in a safe manner so that you can't be accused of stealing them or something???? i am sorry i have been working in a hospital for 3 years and narcotics are counted and witnessed when wasted, ect. so it does make me nervous about doing that in a home by myself. (i think i would love the job, fyi, i just am unsure of what constitutes a "good" home health set-up/employment/agency). thanks so much!
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    About sameasalways, RN

    Joined: Sep '06; Posts: 126; Likes: 15
    RN; from US
    Specialty: 8 year(s) of experience in Med/Surg

    4 Comments

  3. by   merlee
    Most of the patients who are on narcotics at home use a pump, like a PCA pump. The specific type/brand will be shown to you so you can work with it. The pumps are not easily tampered with.

    As for all the home health issues, please look in the archives for answers to the many questions you didn't even know you had!!!

    Mileage payment is a BIG issue, make sure how your mileage is to be recorded and reimbursed. Four years ago the federal reimbursement was about $.50 per mile. It is TOTAL BULL$HIT to get less than the federal amt from your employer. They will get reimbursed for what ever they pay you. DO NOT let them tell you that you can get the difference (if they reimburse you lees) on your income tax. It just doesn't work that well. You have have a large amount for it to count against your taxes.

    You want the reimbursement up front. Some places do it with your regular check, some do it monthly in a separate check. It is NOT taxable income.

    I loved home health, didn't do hospice per se, but had plenty of patients who succumbed to their illness, and went to most of their viewings or funerals.
  4. by   caliotter3
    On regular home health cases, sometimes the agency would have us maintain a controlled substance accountability log, however, you won't find that in hospice. They probably do not bother with one due to the expected short term nature of the cases. When the patient passes though, there will be a form you must sign that attests to the fact that you have destroyed the medications. You take measures to destroy the meds and sign this form as part of winding up the case. That is the time when you would be most concerned about the controlled substances. Although it has never come up for me, I would suppose that your agency would have you institute a control log should you notice that there is an ongoing discrepancy while your agency is providing service. Ask your manager about agency policy now to dispel your concerns.
  5. by   jeannepaul
    In home hospice, no the patients are not usually on IV or pump narcotics, we mostly use pills, liquid meds. We do not count meds everytime we go into the house. We are usually not the ones giving the patient the medications, unless they need it when we are there to do our visit. The case manager will monitor the meds mostly to see if they need refills. Only if they are requesting too early refills, or something seems off, do we try to do something about it. If they are using more than they should, maybe we need to increase dose, freq. to control the pain. I do not question their pain, nor do I make assumptions that they are addicts, because frankly, they are dying so I just try to make their last days/weeks/months we us as comfortable as possible.

    We can get them a lockbox with only one person with the key if a family member is possibly taking them, there are also bubble packs we can use. Or we only give a few days worth of meds at a time.

    When they pass, we do count the meds in front of someone and have them watch us destroy them, either in coffee grounds, kitty litter, or I disolve the pills in hot water and pour it into a diaper. Then whomever watched us, signs the form.

    During crisis care, the nurses at the bedside do have a narc log they have to use when giving the narcotics and they do a count when they change shifts, but that's about it.
  6. by   GinaRN1979
    Where I work our medical director reviews the nursing notes and looks at how often the medication is being ordered. If I write in my note... Mr X takes Percocet 1-2X per day and Percocet is being refilled at twice that amount. We then address the issue with the family. We can place a lock box with only one key for the primary care giver or have 2 Percocet delivered daily.

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