is this dispensing without a license?

Yes, Phenegan is often a part of hospice standing orders for management of nausea. Standing orders are generally signed by the hospice medical director or attending MD upon admission of the pt. to hospice and are used to immediately implement a tx. plan for management of symptoms including pain, dyspnea, nausea, vomiting, constipation, etc. The nurse may suggest this as part of possibly triaging a call from a pt or their family to assist the pt. in the immediate management of the pt's. symptoms. The nurse should probably call back within an hour or so to see if the phenegan actually relieved the symptoms. If no relief, the nurse may make a visit.

It is possible for a patient to be certified to both home health and hospice concurrently and recieving services. Hospice serves the pt. for the terminal condition when they elect no further curative tx and the focus is on maintaining comfort. It is possible that pt. develops a secondary condition requiring intermittant visits from home health (such as a fx related to a fall) and may require PT for strengthening, OT for transfer training of caregivers and home safety as well as a nurse for maybe teaching of levonox injections (which may not be covered by the hospice benefit.)

It sounds like their is an ugency about your request, we're here to help. the Hospice board is a wonderful resource for questions regarding hospice and palliative care.

what if the hospice offers physical therapy? can the home health still go out? and should an lvn offer med advice over the phone without first assessing the patient

The way i am reading the rules and regulations if a skilled nurse is going into the home for hospice then the skilled nurse covers all the problems related to the hospice diagnosis. such as if the patient is diagnosed with liver failure they need to cover the insulin teaching also due to it relates back to the original diagnosis. is this true?

i figure the teaching is for the family and the patient. they need to know what they are takin. i agree about the lvn. however, i am not so sure about offering advice over the phone to a patient without first assessing the vitals and overall condition of the patient.

This is probably more info than this discussion board should be into.

And I have seen erroneous information already on this thread.

Generally speaking, home hospice care usually does not offer PT/OT, because the pt is probably too weak or uninterested in these. PT & OT are usually reserved for people who are expected to improve.

Sometimes there are both Home Health and Hospice on a case when the client needs something acute that Hospice cannot provide. IV antibiotics for an acute UTI, for example.

And, yes, home health and hospice nurses can recommend that patients take their already prescibed prn meds when appropriate, without making an extra visit.

If you feel that your family member is not receiving appropriate care, contact the social worker at the agency.

No, it is not dispensing without a license.

just a minor point adjustment...teaching is a huge part of hospice nursing in the field...it is just teaching of a different nature. We are teaching the family how to care for their loved one as health deteriorates toward death.

This is probably more info than this discussion board should be into.

And I have seen erroneous information already on this thread.

Generally speaking, home hospice care usually does not offer PT/OT, because the pt is probably too weak or uninterested in these. PT & OT are usually reserved for people who are expected to improve.

Sometimes there are both Home Health and Hospice on a case when the client needs something acute that Hospice cannot provide. IV antibiotics for an acute UTI, for example.

And, yes, home health and hospice nurses can recommend that patients take their already prescibed prn meds when appropriate, without making an extra visit.

If you feel that your family member is not receiving appropriate care, contact the social worker at the agency.

The hospice I work with uses an open access model where the pt. and family receive within reason whatever care they feel is necessary and beneficial for optimal symptom management including therapies when necessary or requested. I realize all hospices do not offer the same level of services due to limited resources. I do not feel the information I have given the OP is erroneous, just examples of home health services may completment the services of hospice.

I am curious why you would direct the OP to speak with the MSW re: family member receiveing appropiate nursing care and not the nursing supervisor?

Teaching is not usually emphasized in hospice, rather comfort and pain control, to my knowledge. Teaching should be tailored to the situation at hand. If I were dying, I don't think I would be that interested in discussing the disease process. LVNs should defer to RNs when offering med advice, over the phone or in person.

Why? LPN's can give ordered meds just like an RN can (except for IV meds, in my state). If a patient says they are nauseated, an LPN can decide to give a PRN dose of Phenergan if the patient has an order for it. You don't need to be an RN to do that; I don't feel assessment is a big part of giving that med....you can't determine by an assessment if a patient has nausea, you only can know it if the patient says they are. It's the same as pain. You wouldn't assess a patient and then say, "you aren't really nauseated, so I won't give you medication for it." LPN's are capable of hearing a patient's complaints and administering a PRN medication.

The above is also why I believe it's ok to tell the person, yes, they can take the Phenergan, over the phone. It's their med, it's prescribed to them, why couldn't they take it? I see nothing wrong with suggesting using the med if the patient complains to you of nausea over the phone. If you were there in person, would you say or do anything differently? Doubtful. That's what their PRN meds are FOR. They could take it WITHOUT your suggestion/permission. It's theirs.