Attending Dr not on board with hospice meds...

Your medical director needs to have a talk with that provider and educate them on the palliative care for the patient. If the Dr is not compliant and the family would like improved relief, they should ask for the medical director to manage the care.

ANYTIME you do not receive appropriate palliative orders from a provide you MUST notify your clinical leadership and the Medical Director so that they can help you advocate for your patient.

Good luck!

Might I add.....Do you have a nurse in your office who does community education? Maybe the person who markets? They can also be good resources for teaching primary doctors......ours does "lunch & learns" as an educational/ marketing tool.

At some point in every nurses hospice career, you are going to have a dr who is not on board with hospice. Most are just old school, and of "curative" thinking. Education is important.

I have this one dr, love him to death, but ALWAYS orders soap/water/ leave open to air for ALL WOUNDS. As a wound certified nurse, this drives me completely crazy. Had a pt who had numerous wounds, and he ordered the "usual soap and water". But, when he actually saw the wounds.....suddenly he wanted cultures, IV ABT, and wound clinic visits. I felt like screaming! !!!! Pt ended up revocating, receiving cultures/IV ABT/wound clinic. We readmitted a few weeks later, and is he better? Of course not, the wounds are terminal ulcers.....expected to worsen.....but all could have been avoided if a simple palliative dressing was chosen from day one.

GOOD LUCK!!! Remember you can always get orders from your med director. Ours will sometimes over ride primary ONLY IF in best interest of pt. (This is very gray area though as most med directors dont want to conflict with primaries)Unfortunately, my med director is in practice with the dr who gives ridiculous wound orders, and wouldnt over step those boundaries. You could also see if your med director would just be willing to overlook that particular pt, if primary willing.

I always assume the attending wants to stay on but will always ask, upon admission, if s/he would care the defer to our medical director on comfort measures. I have never gotten a no.

That is true for many docs.

I have worked with a bunch of oncologists, however, that prefer to manage their own patients. By and large they are pretty good at palliating symptoms...not so much managing costs associated with their care. They tend to be used to the non-hospice billing perspective...LOL.

It is great when we can work collaboratively with the community docs and help them understand how to care for their patients at end of life. I find that they respond better to having the medical director (physician) approach them about practice suggestions or recommendations, as a general rule. Having said that, some physicians accept suggestions by hospice nurses quite graciously.

Yep....we have a few like that too. UNBELIEVABLE. Absolutely no quality of life, yet continues to receive chemo/radiation. I feel like its GREED. The dr doesnt care they are giving false hope to the families. They dont realize (or dont care) hospice can help with emotional support as well as end of life decision making.

I had this one pt (on services for

Shame on these doctors....

About 95%of our pts are taken on by our medical director at time of admission onto hospice services. I suppose we are very lucky, as she is tremendously knowledgeable not only about palliative TX modalities, but also about the ever most random, unexpected occurrences. She does an enormous amount of research and from what I can ascertain is "married to her work" (Great for us & pts, questionably unhealthy for HER; though she's a "big girl", & assume she can take care of herself!).

We offer the patient's MD/NP the option to either remain on as the primary once the pt comes on service or defer to our medical director. Nearly all decline, deferring to our Md. She is excellent because when I've called her saying, "pt "x" is experiencing symptom y, & I've never encountered this." She is very quick to say, "ok, please explain to the pt that the latest research on their disease indicates that 45%of individuals will experience symptom y, and that I'd given drug z, should result in total reversal of symptoms within 48°. If not the outcome we find here, the second line approach is to give drug m, along with foot soaks q 4°, & we should experience a total reversal."

She blows me away with her knowledge base, not to mention that she is wonderful with the patients and families, and that level of intelligence + bedside manner is so rare in my experience!

Esquertrian:

WOW!!! What an awesome chick you are to have the privilege of working beside such an incredibly intelligent/dedicated doctor. Ours is pretty awesome too, does a lot of research and reading. Not quite as fabulous as yours sounds though.....If I am ever a hospice pt, I pray I have your medical director (or equivalent) . Your pts are very blessed. Its all about the QUALITY of life. ...