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aimeee 8,358 Views

Joined May 12, '99. Posts: 3,492 (2% Liked) Likes: 117

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  • Jul 22

    I started as an admissions nurse in hospice care after experience in long term care. It worked well as a transitional role for me. As an admissions nurse the main focus is on the documentation of the baseline condition of the patient and the history and appropriateness for hospice care (how well they fit the medicare guidelines) and identifying the most crucial issues for the care plan and getting things started. Collaboration with the team is not only expected, but required, so there is a lot of learning that happens with that process. Explaining the hospice benefit and obtaining signatures may also be a part of the admission process depending on how your hospice handles this (it is in ours but many use social workers or "program reps" to do that part).

    It takes longer to develop the expertise in the symptom management areas because you don't get to see first hand the results of interventions that you put into place. You have to seek out that information by talking with the team. But there is a lot less pressure to know how to handle everything because you know you will be handing things off immediately to someone more experienced. And, unless you work for a very small hospice, likely your knowledge level will be part of what's taken into consideration when admissions appointments are assigned. It certainly would be in my department. If we are admitting someone that we know has a lot of difficult issues, we would try to match that person with an admissions nurse that could best address them. We try to give the "green to hospice" nurses the more straightforward admissions at the start.

  • May 22

    Quote from nosonew
    Pain control: What do you most commonly use? Do you ever fear using too much Roxanol? How do you explain the difference between Roxanol and Morphine Sulfate? Our Medical Director tells me they are TOTALLY different drugs. Yet they are both MS, so I do not understand this. Yes, I know Roxanol is stronger... but that isn't what he meant.
    Same answer as the others. Roxanol is merely a brand name for a form of immediate release morphine sulfate liquid solution concentrated to 20mg/ml. We tend to refer to this particular concentration and delivery system for morphine sulfate by the brand name to distinguish it from the others. Always specify concentration, proper dose in milligrams, and proper dose in millileters to avoid any errors in dosage. Remember, there is no ceiling dose but start low and go slow for narcotic naive patients. For patients who are not narcotic naive, remember to use a conversion to help you select the proper starting dose.

    Quote from nosonew
    Bowel regime: What do you do when you get a patient (new admit) and apparently he/she hasn't had a bm in 7-10 days? (eek!) Is unable to tell you.. and facility he has been at "hasn't paid attention?" (eek!) What would you have done? Ordered?
    I can't tell because I would need to know much more...is the patient uncomfortable and feeling constipated? What diseases/conditions does he have? Does he have good active bowel sounds or are they distant or tympanic? Can I palpate a mass of stool? Is there a physical obstruction such as tumor blocking the progression of stool? Has the patient been eating? Does he have nausea and vomiting? Is he running a low grade temp? (often associated with impaction) Is he passing gas? Is he on a narcotic regimen or diuretics? Does a digital check for impaction find anything in the rectal vault? Does he have any bowel regimen at all right now?

    Quote from nosonew
    Last but not least... (boohoo) HOW do I get supplies that I would LIKE to use, but aren't on in stock (perhaps expensive)??? And I work for a non-profit... (eek!) Help!
    Whether you work for a for-profit or non-profit, the goal is still the same...to provide excellent care but as cost effectively as possible. Are you sure the supplies you want to use are actually superior? Or are you just accustomed to them? If you can show that there is actually a benefit to using them management is likely to approve their order...for instance a study that shows the wounds tend to heal more quickly and with fewer complications...this might mean having to provide nursing time and dressing changes for only 1 month instead of 2. So in the long run the product that is more expensive up front is actually more cost effective in the end analysis.



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