blame the morphine

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Specializes in RN.

I have been running into this a lot lately with my hospice nurse coworkers. Patients' declines and decrease in level of consciousness are being chalked up as "over-medication". This misconception is happening with actively dying patients as well as those with simply an increase in or uncontrolled pain. The patient is typically medicated PRN with morphine for pain or SOB. These are patients who are on starting doses of 5mg range. The knee jerk reaction from this particular small hospice company is that the patients are over sedated from pain meds. I expect this from lay people, but is difficult to deal with from professionals. No one in the company is hospice certified, including the medical director. I have seen a few deaths with uncontrolled symptoms that make me cringe to think about. How would you deal with people who attribute normal declines involving increase in sleep/increase confusion to morphine???

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That's sad to hear from your co-workers. It demonstrates a lack of knowledge and education. Yes, I hear it from family and try and use those moments teachable ones. But your right it is just sad when it comes from professionals.

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Specializes in PICU, NICU, L&D, Public Health, Hospice.

It sounds like you peers would benefit from some hospice education...

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Specializes in Acute Care, Rehab, Palliative.

What role are the doctors playing in all this? Quite often they are woefully ignorant when it comes to pain control. You would think professionals would understand the dying process.

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Specializes in RN.

Thanks all! What resources or classes or books would you recommend to despell these kinds of myths? Like a hospice 101 crash course! And yes, the med director does not take charge of the hospice. In other words he lets the uninformed nurses call the shots.

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Specializes in Acute Care, Rehab, Palliative.

If you Google " palliative care morphine myths" you will gets lots of hits.

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Specializes in PICU, NICU, L&D, Public Health, Hospice.

Use NHPCO and HPNA resources...

Contact your state or regional hospice association...

If your hospice is not providing adequately for the symptom management needs of your patients then you are not meeting your CoPs. How can you say that your patients have their pain adequately controlled in 24-48 hours post SOC when the agency is practicing like this?? These are mandatory reporting data.

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Specializes in cardiac CVRU/ICU/cardiac rehab/case management.

Sometimes people need to hear things clearly. As previous poster suggested your co workers could gain merit from more education. Meantime I personally would be very direct if questioned by simply stating that their perceptions "Are simply not accurate ". Stick with the facts.Pts need advocates like you. Nice job!

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Specializes in geriatrics and hospice palliative nursin.

I'm having trouble understanding how non hospice trained personnel are even providing hospice care As a certified hospice palliative nurse I educate frequently on the myths of morphine and the actual signs of active dying process. Uneducated patients and families and other medical professionals buy into the myth and it is essential that they be educated over and over

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Specializes in RN.
Use NHPCO and HPNA resources...

Contact your state or regional hospice association...

If your hospice is not providing adequately for the symptom management needs of your patients then you are not meeting your CoPs. How can you say that your patients have their pain adequately controlled in 24-48 hours post SOC when the agency is practicing like this?? These are mandatory reporting data.

Lets just say their pain assessments are different than mine. Them missing non-verbal s/s of pain among other issues! I think they believe breathing 50 breaths a minute is just fine and dandy. I am considering a change, but before I do I am looking for some easy and quick educational materials for staff/family.

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Specializes in RN.
I'm having trouble understanding how non hospice trained personnel are even providing hospice care As a certified hospice palliative nurse I educate frequently on the myths of morphine and the actual signs of active dying process. Uneducated patients and families and other medical professionals buy into the myth and it is essential that they be educated over and over

I wish you could come and educate at this hospice! They are RNs and think they are hospice trained. Where I live one does not have to be CHPN to work in hospice. I would love to attend a symposium or class regarding this issue.

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Generally, there is no requirement to be hospice certified to work in hospice. It depends on the particular organization. Personally, I would leave, as quickly as I could given the realities of employment, an agency that didn't have at least the medical director and most case managers certified.

A resource that's handy, free, and readily available with a smart phone, I-Pad, etc is Hospice Fast Facts.

End of Life/ Palliative Care Fast Facts

It's no substitute for a good hospice education program, but it's a quick reference for guidance in symptom control, communication, teaching, etc.

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