Calling Doctor to START end of life Med.

[powerflash]

Hello,It seems every Post I read the RN calls the Doctor BEFORE they can START end of life Medications. Is this a Federal LAW??? State by State?? Do you HAVE to reach the On call Dr. working Eve. or Night shift or can you leave a message? THANKS ALOT FOR ANY INPUT

[tewdles, RN]

Most hospices that I am aware of work with algorythms in the form of standing orders which allow the nurse to initiate care, including medications, without notifying the MD in advance. This format for care delivery insures that the care we can provide is rapidly responsive to the dying person's needs. The use of "comfort kits or packs" containing the typical constellation of symptom management meds is pretty widespread now and is probably close to being considered standard of care. Delivery of that kit should, ideally, be the day of admission to the hospice. Some hospices arrange to have the "comfort meds" provided through the discharging hospital when the people are leaving rather than using an outside pharmacy. No matter how it is accomplished the presence of the pharmacologic "tools" in the home is crucial to the timely response to the changing needs of dying people. AT any rate, the confident hospice nurse sees a symptom, initiates the proper hospice action, educates the patient and family, and notifies the team (which includes the MD).