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:

We do not have hospice at our hospital. It would not benefit our hospital financially and they cannot give up care to staff that is not employed by the hospital. We do not have hospice nurses. It sure would be nice to have a hospice section but I think it interferes with protocol and reimbursment. Many families are not comfortable with a dying family member at their home, so we use comfort care which is actually hospice-like but we make the decisions. We do not call in hospice which is unaffiliated with the hospital.

I work as a floor nurse on an oncology unit, and we have many hospice (and other terminal) patients on our floor. We give them the utmost care and attention, especially if they are alone. They are given a higher standard of corifice than other patients. I would like to think this is the norm in other hospitals as well.

Again, we do not have "hospice" but we have comfort care. It is the same as hospice basically. If we had hospice by law the patient would fall under a different code via medicare and it would involve other employees. I must say that our comfort care is like hospice and good. I am one who always medicates these patients even tho they cannot speak 99% of the time. I would rather feel I am helping with any pain or discomfort. After all, we call it "comfort care" and comfort is what I do well. Once in a while the biggest problem is family who are in denial and do not want their loved one to have medication!!! So when they leave the room, the medication is administered. My patient comes first; not the family.

Specializes in tele, oncology.

Nerd, I'm sorry. I'd have gone ballistic in your shoes. There's no excuse for what happened. Good for your boss, now not only will they know to be on their toes, they also won't be able to use the "I didn't know" excuse.

I take great pride in how I treat my hospice and comfort care patients and their families; no one in those circumstances dies in pain or alone unless some wonky family dynamics prevent it, and I have no problem getting management involved if that's the case. It ticks me off that your patient had that kind of experience...I can't use the language I'd like to or my post would get deleted.

For those questioning hospice as an inpatient, there are circumstances where it's better for the patient. They're always expected to pass in a matter of hours to days, and generally, for whatever reason, family is just not capable of coping with them at home. We put them on a PCA with a basal rate titrated to Ramsey score, push Ativan PRN, and manage O2 needs. The families have 24 hour nursing/pastoral care support.

Obviously, for most, a death at home with family would be first choice, but when that's not possible, we offer another option.

Specializes in MS, ED.
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.

Sadly agreed. When I read the original post, I thought immediately of my own surg/trauma floor. We get hospice patients to our private wing- usually transferred from MICU/SICU - and this could very easily happen on my floor, (likely has.) The dying patient is looked at as the 'fluff' patient, offgoing or transfer RN states 'oh, at least you won't have to do anything for this one.' Charge will often not even count that patient as part of your team and you'll get an extra admission as 'you have an easy one'. Rarely do those patients get the attention that they need; other staff will actually ridicule you for wasting time if you spend time in the room or lend a shoulder to the family. If UOP and VS aren't declining just yet, they're set up on a morphine gtt and nary a second look from most until they sign off the rounding sheet at the end of shift. I've tried to complain - feel awful for the patients and their families - but the unit continues to ignore the root of our problem...staffing.

We're usually 7-8+:1 on most nocs, working with 1-3 techs for 52 beds. Nurses are so burnt with the pace that regular care isn't allotted for, let alone those needed little extras. We get ridiculous admissions that don't belong on our floor along with a nursing sup that tells you 'grow up or quit' if you try to refuse. I have to agree with the previous post that I don't feel this is an appropriate or supportive environment for many patients, let alone those needing sensitive care. JME.

(Before anyone asks - I've put in my time and have requested a transfer.)

Specializes in Home Health.

All I can say is OMG, am a home health RN, not hospice. Some people just don't care and that is sickening!

Specializes in ER, SANE, Home Health, Forensic.

I simply cannot even begin to type the words that could explain the emotions this evokes within me...

I know this post is old, but it made me cry. That's just terrible. Nobody even checked on her?!

my prayers for both you and your patient

Specializes in Operating Room.

Sad story. Why was a BP checked at 4am on a hospice patient? Comfort care means make comfortable.... Checking a blood pressure is usually painful... I would count respirations, check o2 sat, and maybe temp but what difference does a BP make?

Specializes in PICU, NICU, L&D, Public Health, Hospice.

or for that matter, what difference does the O2 sat make?

Comfort care means no vital signs unless a family member requests.

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