Discharge a patient because they go to er?

[AtlantaRN]

Question. Have a patient that went to the er last night. He was having chest pain, he took x3 nitro sl and didn't relieve "10" level of pain. Writer is a good 60 minutes from patient-and he didn't have any roxanol in his home. ((my bad, I was the admitting nurse and without a caregiver, i really didn't think he could handle an ekit-because he is legally blind)).

My manager told me, as we have him for end stage heart, to "discharge him for going to a non-contracted facility." I thought a patient revoking or being discharged was the patients choice (except when a patient is stable and they are discharged for not meeting recert criteria.

Isnt revoking or accepting to stop receiving service, isn't that a patients choice, not the hospice provider?

just don't want to do the wrong thing.

Thank you.

[okielpn75, ASN, RN]

A hospice can NOT discharge a patient immediately for seeking medical treatment. You can offer the pt the option to revoke hospice services. If they choose not to they need to understand that there is a strong possibility that they will be responsible for the hospital bill as Medicare will not pay for both Hospice and a hospital stay for the hospice related disease.

In ANY discharge of a hospice patient you are required to give and have them sign a form that lets them know of their right to appeal. This has to be down at a minimum of 48 hours prior to discharge.