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Discussion

Hospice care

Recently more hospice patients have been admitted to the unit. A few nurses have pointed out improper training for care. The director wants morphine 0.25 ml/5mg q 4 hours scheduled for some and PRN for others. The seasoned nurses are requesting 0.25 ml/ 5 mg PRN q 4 only. 

One nurse has voiced concern after a sentinel event in the past where they had a patient on the PRN dosing. I guess another nurse gave the PRN dose and after 4 hours one more PRN per the patients request and the patient passed that day after the second dose. Well apparently she was blamed for the patient death following policy. The patient had a last rally and didn't show signs of passing.
 

Some nurses don't even feel comfortable giving the morphine.

What is the best way to navigate this situation?

 

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    Do you have inpatient hospice providers entering order? It definitely sounds like there needs to be more education. Whoever is blaming a nurse for a hospice patient passing is clearly not understanding the goals of hospice care.  Symptom management is the most important aspect of care at the time that the patient is enrolled in hospice. If the patient needed the dose for comfort, but then passed away, that's not the fault of the nurse, the patient is expected to die. And the rally that patients often experience can end at any time, and sometimes abruptly. Nurses that aren't comfortable giving morphine (or ativan or other comfort related orders), should definitely be given more education and support about the importance of these medications.  

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    I think an inservice into the goal of Hospice care is warranted for the staff nurses conserned. The primary goal is a peaceful death with dignity. I have given much more morphine to hospice patient's than I ever would to non hospice patients.

    Hppy

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