Hospice failure

[sr2121]

I recently worked on a case that changed my mind about hospice. I have always viewed hospice as not an end, but as a way for PTs to preserve dignity and to help their families peacefully navigate a wrenching process. The pt was 52 old cancer pt with primary cancer of breast with mets to the bone and lungs. When we were called in pt was suffering greatly due to being unable to swallow pain meds. Pt had a high sensitivity to pain meds and was very lucid and able to tell us and family what she wanted and when. Pt decided on PCA morphine pump with pt bolus option. PTs port had to be accessed because venous access was impossible. PTs port was turned and was very painful and difficult to access-- however we got it done and pt achieved pain relief. PTs family was affluent and had several private dr.s attending her. Drs were respectful etc. Another nurse visited pt on shift and reported to med director that there were other doctors attending pt. Med director got his panties in a bunch and ordered the nurse to inform family that pt was being discharged from hospice and to go remove pain pump. Mind you, this woman was actively dying. Removing the PCA due to issues with the port would have been excruciating for pt and for the family to watch. I approached med director to try to find a solution and she was completely unwilling. The other nurse agreed to go to the house. It took one of the PTs doctors literally physically barring the door and not allowing the nurse to remove the PCA. How could this happen?

[toomuchbaloney]

Who ordered the pump?

Hm

Doesn't it matter more that the IDT agreed to the pump and therefore it was incorporated into the POC and initiated?

I am curious as to what transpired that caused the HMD to get his panties in a bunch and demand discharge of the patient.

[Spidey's mom, ADN, BSN, RN]

Who ordered the pump?

That's a hospice order so we go through our team and medical director and then let the patient's own physician know. He/she can "yeah or nay" it but they don't. Patients keep their own physicians and those physicians are part of our team as well. We call them for orders. The medical director is there as a back-up if there is no personal physician and he takes the patient on as his own patient.

I agree - this is a very odd story. The medical director had no right to d/c the pump. This is a hospice team. Team.

[sr2121]

There was no issue with the pump. It was decided on as part of the POC and ordered by our med director. PTs other drs were 100% on board. The pt was being lovingly cared for at home in accordance with her wishes in a safe, clean loving environment. I have gone over the situation a million times in my mind, and there is just absolutely nothing that justified what happened.

I quit this company the day after this happened. I will not be part of a company that would do something like this. I am just haunted that this family had to go through this in addition to what they were already having to deal with and sickened that if it was not for the PTs dr being at the house when the other nurse came to remove the pump that this patient would have been subjected to excruciating pain as she was in the final stages of dying. It goes against everything that I believe and everything that hospice care is supposed to stand for.

[toomuchbaloney]

Sounds like the family has grounds for legal action against the hospice and their medical director, I am sorry to say.

One cannot simply discharge a hospice patient, particularly one with symptom management needs, without cause.

If the family pursues they would likely win, in my experience.