FLArn 8,838 Views
Joined Jan 6, '02.
Posts: 532 (62% Liked)
I missed hourly too. We do vitals only once per shift or visit except for temperature or respiratory rate to chart effectiveness of an intervention.
First, if you are unable to obtain a value for the particular VS state just that "unable to obtain BP" and then proceed with the rest of the values you are able to obtain. For example, VS BP UTO, P 98, R 20, T 99.4 F Ax.
Second, in my experience, O2 Sats are by MD order only and are rarely if ever ordered (generally only for peds cases). We treat respiratory issues by assessing the symptoms and patient reporting. For example, use of accessory muscles, cyanosis, restlessness, increased respiratory effort to name a few. The best way to chart is to record what your patient says and what you observe. The best way to know what to include in general is to chart to support the plan of care and document the progression of the terminal diagnosis.
Perhaps in the past when they lived together in the same home, either hers or the family home, dear old Dad used the bathroom just before dinner (or maybe she just has a bowel fixation). Either way, I would have the CNA take him to the BR on the way to the dining room since daughter is there an hour before that should take care of the problem. If he doesn't want to "try" before dinner, have the CNA remind him that this way he'll get to eat a hot meal.
If I am reading the original post correctly the OP took 2 other staff with her to restrain the agitated patient so that she (the patient) would not move unexpectedly causing the OP to accidentally stab someone else. No one got an accidental stick.
I am so sorry you had that experience and kudos to you for attempting to advocate for your patient. The thing to always remember is that "we" hospice are guests in the SNF and must play by their rules. Sometimes trying to educate staff that what they are seeing are the signs of the very end of life and the patient is in extreme distress may get them to try and get an order to use from the E kit. Remember that use of the Ekit in SNFs is not as simple as opening the kit and signing out the meds. It may involve a hard copy signed script from the MD to the pharmacy if not an actual phone call to the pharmacist from the MD. Also most states prohibit or strongly discourage the use of psychotropics for ANY reason so the SNFs simply do not stock them in the Ekit. (Sorry, Dr X that's not in the Ekit. What would you like to order instead?) Unfortunately the presence of hospice patients and their special needs are simply not addressed in the regulations that determine care in the SNFs.
When possible it is good to have a PICC or Port if the patient has a longer prognosis (weeks to months as opposed to hours to days) so as to minimize the number of venipunctures needed. But it is entirely possible to infuse Morphine via PCA in a peripheral line, it is even possible to get effective relief from a subqu site. I've seen all of the above used effectively.
I never found that it took that much extra time. Also the one time I tried to "save" time by mixing the meds, they congealed into a horrible thick glob in the plastic cup so I had to discard the whole mess and repour the meds; then I had to order replacement doses for all of them. So much for time saved. I don't remember what the meds were since this was very early in my career.
And when the state surveyor is following your med pass. (Actually I always gave each Gtube med separately and never gave meds - e.g. Tums, cough syrup - without an order because your patients' or families will rat you out in a heartbeat and never know they've done it) " What do you mean I can't have a Tums? You gave me one yesterday!"
Based solely on the information contained in the question; I would say no as you state that there are no refills. So technically you have no order for the prn medication. I would say you need to call the MD get a new order including the order to use from the ekit until pharmacy fills the order. The procedure for actually removing the med from the kit would depend on your facility policy.
It is possible to have your nails professionally manicured and buffed to have a kind of a sheen without having artificial nails. I am terrible at shaping my nails so they are more or less uniform so I see the manicurist just for trimming and filling. I treat myself to a pedicure with polish in place of my acrylics!
However, if the patient has not revoked hospice, the hospital may not be able to bill Medicare for their treatment of the patient's exacerbation of the terminal diagnosis as Medicare will not pay for both aggressive and hospice care for the same diagnosis. Somebody isn't getting paid, and if it ends up being the hospital they may bill the patient/family. The hospice will inform the hospital that the hospice is not responsible financially since the treatment being provided by the hospital is outside the hospice plan of care. At least that is my understanding of how the hospice election reads.
I have taught many skills to FAMILY caregivers who are willing to learn, however, I would never attempt to teach nursing skills to unlicensed paid caregivers. That is an entirely different matter legally. Family members may learn whatever skills are needed to provide care but HHAs, CNAs etc are limited by state practice acts as to what care they are allowed to provide. If you are uncomfortable or unsure what can or can not be taught to paid caregivers, contact your education department or risk management.
Check with your supervisor or the education department to see if your company offers ELNEC training. Also find out if they offer any sort of computer based education. Also if you are in a position to join HPNA (Hospice Palliative Nurses Association) they provide access to many educational online opportunities.
NCIS for me too. Also Elementary and several on HGTV channel including Love It or List It and Property Brothers! Medical shows just get my BP up
I have been a hospice nurse for 10 years and have never heard of anything so outrageous. This was never a part of ANY clinical position I have held in ANY setting. (LTC, Home Health or Hospice)
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