It shouldn't have happened this way....

Specialties Hospice

Published

Okay, so I work part time with hospice. I like it. It's a nice break from feeling like I'm torturing souls their last days on earth up in ICU because their family of freeloaders are all living off their granddad's check....

Get a call from the hospital, one of our inpatients has died. It was expected, the poor woman was eat up with cancer, and threw a massive CVA from it. After being admitted for the CVA, family agreed to hospice. Pt has expressive aphasia....but I had her as a patient in ICU, and she recognized me when I came into the room, because she started crying and trying to talk. Did the PRN visit, adjusted a few meds, held her hand and talked to her. She kept throwing CVAs over the weekend and finally she died this morning.

I walk into the room, and I swear I wanted to go back out and choke the living daylights out of someone. Her BP had plummeted at 4am....and nobody called the family, nobody'd even called us. She's dead in the bed, and you can tell she was trying to crawl out of the bed, and her callbell was in the chair beside the bed...out of her reach. She was reaching over the rail, her eyes were still open and she was looking at the door. That woman was trying to call for help, for someone to hold her hand while she died, call her family, something, and the callbell was out of reach. She was stone cold, and rigor had set in. She'd been dead for hours.

I just closed the door, sat down by the bed and held her hand. I'd made all of our promises to her...we'd do everything we could to keep her from hurting, keep her from being scared, we'd be there when she needed us. Nothing happened on that floor last night -- no codes, nothing exciting that would explain why nobody checked on a dying hospice patient for hours -- nobody called her husband or children so they could come and be with her.

She died in the dark, alone.

What the heck is wrong with people?:crying2:

Specializes in ICU, Telemetry.

I've been worried to death about our other inpatient hospice patients....most of them can't tell us what's going on, and I'm scared now that they're just left to their own devices until right before we and family start showing up --- fast linen/brief change, pain meds given, etc. The next day I work and we have an inpatient, I'm going over the records with a magnifying glass rather than believe what they're telling me that they are doing. including interrogating the Pyxis to see what's actually being given and when.

If you have inpatient hospice folks in the hospital, please, please make sure they're being looked after. This was the one place I thought they'd be safe and looked after. Not anymore....

Specializes in ICU, Telemetry.
Oh, I re-read and it appears she was not in ICU. Family ought to have been there already, or called. Sad.

No, she was on the M/S floor. Her hubby was very frail with a walker and galaxy of health issues himself, and the daughters were in from out of town; they would bring him up after breakfast, and they'd stay until after supper. They were staying with him at night, as the wife had been his primary caregiver. Now he'll probably end up in a NH, and in 6 months to a year's time, we'll have him as a patient.

I just still think I'd feel better if I could go smack someone....*sigh*

Specializes in onc, M/S, hospice, nursing informatics.

We have had similar situations in our hospital. These patients sometimes seem "forgotten" by nursing staff. "Oh, they're hospice," has been overheard more than a few times, like they somehow don't deserve the same caring attention if not more than other patients. Just yesterday I had to write up a nurse for leaving a heparin gtt running for 15+ hours after they went on hospice (meaning they had a new case number without the heparin on their profile), without PTTs having been drawn for >48 hours. Then, today, same patient, I found out that a "now" order wasn't given until four hours later (and it was charted "audible congestion" - wouldn't have happened if the med was given on time and at frequency of order). You wonder sometimes how some nurses keep their license for so long.

Sorry this happened to your patient. Please make sure that management is made aware of this.

:crying2:

Wow, I am so sorry to hear about what happened to that patient and about the sadness you are obviously experiencing from the events. I am currently a CNA in a hospital, and just recently had my first experience with a terminal (not sure if they were actually on hospice, but I was told in report daily that they were dying) patient who passed while I was on shift. I know not everyone wants to be the person holding someones hand as they are dying, but it is so hard to think that no one on shift was checking this patient enough to be there, or at least get someone else, preferably the family there. Your story is horrifying, but hopefully those that read it will see why even if you aren't too worried about your dying/hospice patient you need to check them often. Also, this is a horrible but real picture of why providing comfort to a dying person is so crucial even if you are 'just' their healthcare worker. Thank you for sharing, I hope having someone like you in your facilities hospice will improve the level of care given. Remember, fighting for your patients rights is a core responsibility of nurses, bringing this to someone's attention is the right thing to do!

Can't you still talk to the charge nurse of whomever was supposed to be caring for that patient? Didn't anyone check on her at all at four am?

Specializes in ICU, Telemetry.

I'm going to let it roll boss to boss, where there's a chance something will be done. If they didn't care about a dying patient, they're not going to care what I have to say about it....

Specializes in LTC, assisted living, med-surg, psych.

This just makes me sick to my stomach, Nerd. :scrying:

I've never been a hospice nurse, but I've worked so extensively with hospice over my years in long-term care that I've become fairly knowledgeable about caring for terminal patients. At my assisted living facility, dying residents are checked visually every 15-30 minutes when they're close to passing. We don't want them to die alone if we can possibly help it; if family can't be present, usually one of the caregivers or I will go in and sit with the resident until someone from hospice comes in, or until it's all over. In the meantime, they're medicated appropriately for any s/sx discomfort, repositioned, linens changed, whatever they need.....there's really no excuse to do any less.

So, if this kind of care can be handled by four caregivers, two medication aides, and one RN in a facility with 90 residents, why can't a hospital manage better? That is just inadequate medical care no matter how you slice it, and I hope the OP prevails in changing her hospital's handling of terminal patients. It's shameful, and heads need to roll.

Specializes in pediatrics, geriatrics, med-surg, ccu,.

Reading this makes me sick. This poor woman was alone, was terrified, and was trying to get someone to help her. The treatment that this woman endured is awful! Someone should have been checking on her. The nurse assigned to her and any cna's assigned to her should be written up. This is horrible! I would take it all the way to the top. If it had been a family member that walked in and found her, there would be alot more questions in regards to how this happened. This patient certainly didn't recieve the comfort, or care that she deserved nor did the family. All I can think of is WOW! HOW AWFUL! My heart goes out to the family and to Nerd..I can imagine what it was for you walking in and finding your patient in such a state. I would have been horrified seeing this poor lady that way, and heartbroken that this even had this happen to her. Heads certainly need to roll!

Specializes in ICU, Telemetry.

Thanks, Viva...it's good to know people are doing the right thing somewhere...

When I was in telemetry, and had someone who was close to passing, I'd put telemetry on them just so I'd know when they started getting ready to go...I never wanted to walk in and find my patient had been dead for the time it took me to bathe and do wound care on someone else. What kills me is, they weren't that busy (no admissions, no codes, and the nurse had 1 other hospice patient who was no trouble at all, care being given by a very self reliant family, and 2 walkie talkies that got dc'd the next day. Whoever took that BP knew the pt was dying...why didn't they just pick up the phone? They wouldn't have had to do anything but be there for the pt during their last moments on earth.

Specializes in med-surg, geriactrics, oncology, hospi.

In light of what I've seen in my years of nursing, hospice should have never become an option in hospitals. Hospice was created for pts. to get nursing care AT HOME around familiar surroundings & FAMILY. That whole concept is missed these days.I know it started in hospitals due to more days of insurance coverage that way but the pt. gets cheated. In a hospital, if pt. becomes "hospice" that means a step-down in care given & time spent in the room by staff, not more as some here seem to think. Hospice is comfort care only so interventions are few.It is probably much better in the home setting as it originated because there the pt. & family get the staffs undivided attention as they should. That won't happen on a busy hospital floor. And forget familiar surroundings which are a comfort to a dying pt. & more conveniant for family.The post Oct 4th says family were called- where were they?? Seems they failed the pt. also. It is all very sad, but again, hospice should be @ home- none of this would have happened.

Specializes in Long-term care, finance, appeals, more...

There is absolutely no excuse for her having died alone. Having the call bell out of reach is the same as using a restraint.:crying2: I agree with the caller that a write up is warranted. But not just for one person but for the nurse, CNA, and anyone who was assigned to the patient along with the charge nurse that night for that particular floor. Agreed, the CNA who took the blood pressure should have notified the charge nurse or the nurse assigned to the patient and someone SHOULD have called the family. My mother died in an emergency room on January 4, 2010 with only my father present who had been summoned after my mother had not received an appropriate level of care following a fall with sustained head injury three days prior. I live in another state from where my mom lived but my brother didn't and was very close to my mother. My brother was not notified until after my mother had died because there was so little time. The woman in this story....it should not have happened the way it did....we all have to die alone but the dying process should be filled with our lived ones, comfort, and dignity whenever possible.

Terri, RN BSN

RN since 1990

Write up.. Someone is not awake at 4am.

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