Hospice and litigation question

mc3, ASN, RN · Oct 29, 2005

Suebird,

We used it extensively also at the hospice I used to work at. It's a marvelous drug, worked great, and we had no problems using in our LTC facilities. The hospice I'm now at won't really consider it d/t the "confusing" dosage regime, but it's really not that bad. And, if I'm not sure on conversions of titration, I call HP!

I'm also interested in the hospice and litigation question....we have an MD who is very "shy" with his opiods. :angryfire I was told it was because he was involved in a lawsuit last year.....well, if that's the way he feels, maybe he shouldn't be in hospice at all :angryfire but that's a different story!

mc3

Red Hat Momma · Oct 29, 2005

We use methadone in our LTC Special Care Unit, and our dosing is every 4 hours from 8 am to 8 pm and it workd wonders.

As far as physicians and litigation, I've not heard of it, but in the past, state surveyors have given poor surveys regarding pain control. Of course if there is a problem with the physsician not prescribing enough pain control medicatins, you have options such as talking with the hospice nurse, family, the medical director ansd on up the chain of command. In our ares we have excellent hospice nurses and medical directors for hospice. They not only rely on us and our opinions, they look to us for direction because we are there on a daily basis, and most of the time have known the resident prior to hospice care.

Al Stephens · Nov 2, 2005

katilac, we use methadone here, in west texas, for severe pain control, and if other meds dont cut it. we also use 10 mg ms sl for breakthrough when not using the methadone. yes, it is cheap, and yet, with the patients the stigma is hard to break....

katie'sangel, BSN, RN · Nov 3, 2005

Physicians are concerned about the tracking of their opiate prescribing habits and as a result, the terminally ill elderly are often undermedicated for pain, particularly in the skilled nursing environment. Lately, I have "heard" of more and more instances of litigation by families because pain control was not managed well. I am seeking hard data and information on specific cases and outcomes. I have been told many times by physicians I know that they fear referring to hospice as they are unfamiliar as well as uncomfortable with the pain management approaches used in palliation because it deviates from their "norms". I would like to be well informed on both sides of this equation for discussion purposes.

I have a solution for the MD uncomfortable with hospice level narcotics. He/She should admit the pt to hospice program and let the hospice MD cover the patients care. Our hospice MDs understand how much Rx isneeded and because thier specialty is hospice, there's little question about the large doses:)

jsteine1 · Nov 9, 2005

That is the solution, but unfortunately, before we can get that patient under our palliative Doc, we need to get some minor level of cooperation at times from the attending or family doc in the first place. Also, a lot of docs dont want the palliative doc to take over. No more billing for hospital and office visits, so its a revenue loss.

mab19 · Dec 5, 2005

I'm a hospice RN and also have my JD. To bring successful litigation in this area you'd have to show deviation from the standard of care and resulting harm to the pt- something difficult to do in the area of pain management. Would be interested to know if anyone else is aware of any litigation on this issue.