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:

What I see here is a hospice patient in an acute hospital. That is a large part of the problem. With so much going on with surgical patients, etc. it is easy to not go into the room of the person who is not pushing the call light. Sad, but true. I make it a priority to give them pain medications even if they do not look to be in pain. How the heck do I know? I just know they are dying and it ought to be as comfortable as possible. If a patient is to be lingering in this dying state, the patient ought to be in a different type of residence. Maybe that would have made a difference. We do not have hospice at our hospital. People go home, or go to nursing homes on hospice. If our patient is dying, we do comfort care. In the story given, it appears that perhaps the case manager, etc. did not suggest a better place for end of life. Home would have been best, if possible.

Specializes in Geriatrics, Hospice, Palliative Care.

I've got agree with Needshaldol; a hospital is the wrong setting for a hospice pt, but perhaps that was in the works and she died too quickly for that to occur. I work in a SNF and it breaks my heart when one of my beloved pts dies in the hospital - I KNOW that they are not getting the loving care that we could give them, simply because we know the pt's history, likes and dislikes, and their life history.

Nerdtonurse (that's me, too - I was a high falutin' secretary - no matter what my actual title was - for 20 yrs before I became a nurse) I'm so sorry that your pt suffered like this. I'm glad that you are going to pursue it. Did you speak with any of the nurses at the time of the event? I've had many shifts were we're crazy busy avoiding the serious stuff like a code, and on paper it appears as if we had an easy time of it, when it was all of the maddening work that kept things from going to heck - but you wouldn't know unless you got report from me (:

e

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

In response to Needshaldol, I also do these things- part of being a conscientious nurse.I always call family c a turn of status or events (not hospice pts,) but in this situation, the nurse probably thought the family didn't want to be there or they'd been, c her being hospice.I don't know that I would have called family under those circumstances. We call the hospice nurse who is off-site when the pt. passes. Where I work, family overflow in a situation like this.They usually do most of the care which is basically being c the pt. Some don't even like the nurse coming in.

Specializes in Medsurg/ICU, Mental Health, Home Health.
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.

At my hospital we are actually not allowed to do this. Once a patient's DNR order (we have a 3-tiered system) has indicated that no meds to correct dysrhythmias will be given, the telemetry is removed.

I agree with you, and I wish this was an option for me. When patients are hospice in the ICU (it happens occasionally if death is expected soon after withdrawal of care), I'm not sure if the monitors stay on the patient. But for MedSurg and stepdown, those patients can NOT be monitored.

As the others have said, I'm very sorry to hear this. I applaud you for your work - I do not like having hospice patients. I prefer the rush of emergent interventions! I hope that your discussions with your boss end in something positive.

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

Hospice pts. NEVER have tele- comfort care only. I have never heard of hospice care in the unit either.

I have yet to hear of an acute care hospital accept "hospice" in the hospital. When a patient goes on hospice, the hospice team takes over. How does this work in an acute hospital? We have a palliative care team, but they do not give orders. What we do is "comfort care" which to me is exactly like hospice, or rather hospice in an acute care facility. I truly do not understand how hospice works in hospitals, perhaps; these are "for profit" hospitals?

in nsg school, there was a dying pt across the hall from the pts i was assigned to.

not once during the shift, did anyone enter his room, as was confirmed by a few of the students.

when they say ekg changes, they gathered some of the staff and students and formed a circle around his bed.

never said a word to pt, just the staff holding hands encircling the pt.

truly, i found it offensive and disingenuous.

that is not my idea of comfort.

had they told me he was dying, i would have been honored to take him as my pt.

i'll guarantee you, he would have received 1:1 attn all day long, to extent possible.

note: hey people - it's ok to actually touch and comfort someone when they're dying.

for the most part, 'hospice' in a hospital is fruitless.

there are some families that stay with pt until the end.

and when hosp nurse enters, they are usually not welcomed.

but then again, there are far more pts who die unattended and alone.

heartbreaking.

leslie

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.

This is simply incorrect. We often have people in the hospital simply because there is not enough family to provide loving care at home. That said, I have this week watched two different hospitalists panic the poor wife of one of those who can't be cared for at home.

I'm sorry the poor woman died so frightened and alone.

http://en.wikipedia.org/wiki/Cicely_Saunders

ETA: And comfort care only applies to the terminal diagnosis. Comorbidities may be and often are treated.

Having a dying patient at home can be impossible for some. We cannot judge. Families are not educated early enough to know what is best.

This makes me so angry, and sad. How horrible. I fear, though, that your managers may not want to "ruffle the feathers" of the hospitals' managers. I worked in hospice for 7 years, and many times I saw things that shouldn't have happened in a facility. When I brought it to the attention of our management, they said "you have to remember, you're a guest in their facility" and take it no further. Never mind what was best for the patient. They were afraid they wouldn't get any more referrals. It made me sick - it was one of many reasons I left there. I hope I'm wrong.....

(((((hugs)))))

mc3

:nurse:

Don't get me going on hospice. I find that hospice is useful in few cases. Most people at end of life do not need hospice unless they need a free use of a bed that is easy for the family to control. Hospice takes over the primary doctors duties and the doctor is probably very happy. But hospice is a paid position. There are a lot of staff at hospice, a lot of $ that goes out to staff. Sorry folks, I have seen it with my own two eyes with both parents. I fired hospice twice.

I am so sorry your patient had to die like that. It brought tears to my eyes.

I have to say that the one inpatient hospice exposure I had was not like that at all. My cousin died of cancer of the liver a couple of years ago. When she got beyond the care oncology could supply she was moved to the hospice floor in the hospital. Those nurses did regularly check in on the patients from what I saw. My cousin was clean and turned regularly. She was pretty doped up, really floating on a cloud you know. But I really appreciated the way the nurses still checked on her.

When she was passing they did call my mother and another aunt who had been primarily the contacts for her. Both of my cousins parents were already deceased. The other aunt had health issues of her own that prevented her from going to the hospital. My mother went, and because the staff called my mother was able to get there before she passed.

Now there were other patients on the floor, at least four or five if I remember correctly. The floor had two wings and I was only familiar with one side. From what I could see they did seem to keep tabs on the patients. Just wanted to say that I have seen good inpatient hospice care. Hopefully your situation will get the attention it needs so that another patient will not have to go through this. Peace...

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