End of life liquid meds vs crushed

[Race Mom]

So, if you have a pt that is within 1-2 days of end of life, has thrush causing difficulty swallowing, when do you change meds to liquid vs crushed? What would keep you from opening the comfort kit at EOL? Is it ok to give pt the [COLOR=#444444]Hyoscyamine[/COLOR] from the comfort kit, even though it "causes urinary retention"? If a family member calls you on a Friday at 1630 with c/o pt having pain crisis and family requests visit to utilize EOL kit, is it ever ok to say no and direct family to continue to crush all meds or give them rectally vs visit to open comfort kit for liquid meds and not visit? Yes, your guess is correct, this happened. It makes you want to open your own hospice in that town.

[khooker200]

I am so sorry!

There are usually standing orders - so I am not sure what they were talking about....

In any way, I am sorry that your sister death was stressful and that hospice was not helpful.

Also, the MD has to sign an order to obtain a kit. The first incident I would have revoked and sought out another hospice plain and simple. And yes, the kit is in your home, it is actually your possession per new laws. We cannot even dispose of them anymore legally at time of death because it technically belongs to the patient and family. Everything that happened to you is everything that is wrong with certain types of hospice agencies trying to profit from this hard and terrible time for patients and families.

[Race Mom, ASN, RN]

I would have revoked if I had a choice. (I was her MPOA) Unfortunately, they were the only hospice in the county. The ONLY one. So, the night she had a seizure, besides no answer at the hospice number, and no way to leave a message, by the time we got ahold of someone (continued to try to call them), the nurse was in a town that is over an hour away and was with another pt. This is a non-profit hospice. I do plan on filing a complaint. I just need to get through some grief first so that my letter is professional instead of fueled by emotions. I am guessing the spouse will get the survey, so this may not help. He is aware of the issues, but as a non-medical person, he wasn't aware of what was going on because he didn't know any better. If I lived in Florida, I would really be thinking about opening a hospice in this community.

[Race Mom, ASN, RN]

Thank you everyone for your loving words. It was hard enough to be losing my sweet, young sister, but couple that with advocating. You will never question yourself more in your life. Her death will pain me forever.

[Kitiger, RN]

I would file a complaint. And I would absolutely put this down on the survey. Also bring it up with their ethics committee.

You may not be ready yet, because you're grieving. But this is something that you can still do later.

I'm glad your sister had you. (Hugs)

[Race Mom, ASN, RN]

Also, the MD has to sign an order to obtain a kit. The first incident I would have revoked and sought out another hospice plain and simple. And yes, the kit is in your home, it is actually your possession per new laws. We cannot even dispose of them anymore legally at time of death because it technically belongs to the patient and family. Everything that happened to you is everything that is wrong with certain types of hospice agencies trying to profit from this hard and terrible time for patients and families.

In the hours, after she passed, the OC RN came to the death call. The first thing she did was start to destroy meds. She was ready to destroy meds that never were filled by their hospice (she had the bottle before electing hospice) and I said "those are not your medications, those were purchased by her. You don't need to destroy them". To that she said, "well, will have to document that you are requesting these meds not be destroyed." Whatever.....they were filled well before hospice came on board and hospice had nothing to do with those meds, nor did they pay for them. But, they destroyed plenty of meds. And then...she left. She did ask if we wanted her to stay until the funeral home arrived. There was no reason to have her there, so she left. It was 3 days before the medical supply company arrived to take the bed, etc. That was unacceptable. Three days of a hospital bed, commode, walker, etc sitting around. The hospice I worked for would have had it out of there in hours, to ease the pain of the family. 3 days!

[messymissy]

OP, I just want to say how terribly sorry I am for the way your sisters passing was dealt. I myself am dealing with a sister (only one) who has a terminal diagnosis. I am so fearful that her death will be treated the same way. My advice is to file as many grievances/complaints that you can. Maybe you complaints will prevent these things from happening to another person.