SNF asking hospice to change meds

[silverwillow]

Does anyone else have any experience with skilled nursing facilities asking hospices to lower patient's Ativan doses so that the patient meets Obra 22 guidelines?

I have a patient that takes Ativan 1 mg every 8 hours prn. She has COPD and needs it. She's been at this dose for years. They want me to change it to every 12 hours so it fits in with Obra 22. Does that even apply to a hospice patient not taking the med for behavioral reasons?

Hope to hear from someone on this real soon. Thanks

[ReluctantMonk]

What I wrote is our company's policy. Since we are not an employee of the SNF we cannot take orders from an MD for the patient, we can only ask the facility to call the MD with our recommendations. I know of hospices in this area that contract the MD directly, and I was only describing our policy

[EmptytheBoat]

I'm with doodlemom on this one, what good is hospice it they are

not initiaiting orders, that's what is all about. If up to SNF, patients

wouldn't get what they need, they haven't a clue for the most part.

[doodlemom]

What I wrote is our company's policy. Since we are not an employee of the SNF we cannot take orders from an MD for the patient, we can only ask the facility to call the MD with our recommendations. I know of hospices in this area that contract the MD directly, and I was only describing our policy

If your agency has a contract with the facility you should be able to write orders in their chart. That is part of a standard contract between a nursing facility and a hospice. Generally facilities will not let an agency in to see their patients if they don't have a contract with you. If you have a hospice patient in their building, you must have a contract with them - it would be a horrible liability for them if you didn't. They would end up with deficiencies when Medicare or the state walked in the door. You should also be able to take orders from any MD - especialy the attending physician. Whi is writing hospice orders for these patients? If this is just a matter of a policy with your hospice, I would talk to your administrators. Your hospice will never be able to compete with the other agencies who do everything possible to make life easier for the facility staff. Out of curiosity, are you working for a non-profit?

[rubyhospice]

Hi. I do run across that occasionally. If the SNF care plans that lowering the dose can cause discomfort to the resident, who is on comfort care, it is usually o.k. to keep the present dose. Also, if possible, the resident or family can object to lowering the dose based on past experience with changing her/his meds.

I hope this helps you.