Ok, the problem that I have is with Hospice and the rules. I am a LVN at a hospital and I had a pt last night that is on hospice. The Dr. and the family is waiting for the guy to die, so at the start of my shift the Dr. had ordered for the pt to receive Dilaudid 1mg EVERY hr PRN. However I did not feel comfortable giving that much and I told the family that it is PRN and the pt was sleeping and VS were all normal. So I gave 4 doses thru out the 12hrs, so he did not die thru the night. The Dr. got there at 5am and noticed the pt had not died yet, he took the charge nurse aside and told him to have the family step out and smother him with a pillow! He in turn told me what the Dr. said and I about freaked at how he could even say such a thing. Anyway, the Dr. came back at 0700 and ordered Dilaudid 1mg every hr (not prn) and adivan every half an hr until death. Of course the Pharmacy called up to clarify the order and told the on coming nurse that she did not have to give that much and to use her judgement with it. She had the same feeling as I did. This is not right and she also said there was no way she would give that much just to speed up his death, and with 5 other pts there was no way to even keep up with it.
So, what can I do or because he is on hospice it is ok to give him lethal doses to speed up his death.
P.S I just called to check to see if he had died yet and he is still alive, with good vital signs.
Jan 8, '12
The OPs story does not sound far fetched to me.
Death by morphine, administered by the nursing staff, is not as far fetched as most people would like to believe.
Last edit by imintrouble on Jan 8, '12
: Reason: Discretion
I agree with Leslie that the OP as written is completely wrong, wrong, wrong.
But, I'd be interested in hearing more about the context. What did the patient need to stay comfortable before he became unresponsive? Are these new dosages or an approximation of what the patient was previously taking?
We have no way of knowing what a patient feels if he is not able to talk to us. Vital signs are not always a clear indicator.
Euthanasia is not part of the hospice mission. Period.
That being said, hospice caregivers do most of our work in the gray areas of medicine ... blanket statements about "death by morphine" are a profound distortion of what we do and why we do it.
ETA: I have had a number of patients, primarily end-stage COPD, who could not be awake at all without being in a panic as they felt themselves strangle. I gave meds precisely to make sure they stayed asleep as it was the only way left to give them any peace at all.
It's all about context.
Last edit by heron on Jan 9, '12
: Reason: added point