Hospice Inpatient Units

[Raicho, BSN, MSN, RN]

Hi all,

Anyone who works in a hospice inpatient unit, how do you deal with multiple admissions at the same time? How do you prepare, so when you get slammed, its not so bad? How have you become more effective and more efficient? How do you use volunteers to help, or do you not?

[AriRN36]

How often are you getting multiple admissions at once? How many nurses work on that unit each shift?

Your intake department should be setting you up for success by staggering admission times.

[Raicho, BSN, MSN, RN]

We are a stand alone facility with 24 beds. We usually will have 3 or 4 nurses, plus a Charge, and 2-3 CNAs, depending on census.

Apparently, in the past, when admissions gave hospitals specific times, the hospitals saw that as pushback and stopped sending us referrals. We lost a huge amount of business because of it. So we are not allowed to set times. So I am trying to work around that as it cannot be changed.

[AriRN36]

Well, that sucks. The two things I'd say are: lean on your team and use a checklist.

When we'd get ICU admissions, it was floor culture that everyone who wasn't doing something emergent would be there in the room with you when a new patient came. In an IPU I'd hope the same would happen - and that's a two-way street. They help you, you help them when they get an admit.

As for a checklist, it helps when I have to stop mid-task so that I don't have to look back at everything I've done each time I return to a task and waste time.

Hopefully that helps you a little. I know our situations aren't the same.

[verene, MSN]

That sucks that they don't give you times... even having a time window is a HUGE help (I've also never worked anywhere hospice/non-hospice where they can't give at least a window of time...., or have sending facility call when patient is leaving to provide ETA so I don't know why this is huge pushback in your area).

Having a checklist helps as does having a team that works together well. As does having admit bundles (either paper or EHR or both depending on facility) with all forms organized in advance. Delegate tasks as appropriate, and work in small teams and combine tasks as able (e.g. skin check combined with bed bath on admission). 

If you have lay volunteers they can often help as extra hands and can be used as runners/stockers depending on your facility policies. We had our volunteers follow a checklist to make up pre-packaged "admit kits" with all the basic supplies we would likely need on admission for a patient which helped cut down time running around trying to find things. If we needed something extra (e.g. extra blankets, pillows etc) we could send them to grab it while we continued on with admission.