Comfort kits

Specialties Hospice

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We have a comfort kit but would like to maybe change it some, so I was wondering what other hospices have in your comfort kits, I have heard of different kits for different diagnosis, ie: specific kits for COPD and a different kit for Ca patients. Thanks!

Mandee

Specializes in Med Surg, Hospice, Home Health.

my philosophy on e-kits---better to have it and not need it than to need it and not have it. roxanol for dyspnea/pain/breakthrough pain, ativan for anxiety, haldol, tylenol supp, compazine supp, phenergan supp.

with a base cost of $44 with delivery, we usually order ours on admission.

even if patient has never been nauseated, you KNOW it will happen at 2am. Patient and family are not going to wait for a pharmacist to be called in and then a courier to deliver-if meds for emergency use are not there-they are going to call 911..............

I couldn't do my job without e-kit availability.

Specializes in L&D, Hospice.
Dear Rock-Chalk,

I am not a nurse, but rather a family member/caretaker of someone who just started receiving hospice services at home. Today, a pharmacy delivery truck pulled up to the house, and they delivered a small box that's sealed shut and labeled "for use by hospice nurse or physcian only". It is also labeled "not child-proof." They told us to refridgerate it, and, when we asked the hospice nurse about it today, she replied that it's not for us (the family) to use but rather just for the nurse in an emergency. She offered no further explanation. From reading several web sites, I assume it is either a comfort pack or a cardiac pac, and I now know the contents of both.

Quite frankly, I can offer a family member's perspective by saying that I don't like having something in our fridge without knowing what it is or how it's to be used, and I worry about potential liability because we pay for three other caregivers during the day who are in and out of the house, including one who lives close and has young children. And, per your astute question, I don't know what the heck we'd do with it if my dad were to pass. We had no further instructions other than basically not to touch it!

Primarily because of the poor communication, I'm on the verge of calling hospice and telling them to take us off the list and get their stuff out of our fridge!

Your sister Jayhawk (but displaced to a land with less coordinated health care),

pjkt

shame on the hospice nurse for not explaining!

I always explain exactly what meds are in or little pharmacy bag they are to keep in their fridge (ok, if people are overwhelmed with all the new info in the beginning, i will tell them they are meds we might need in an emergency, weekend/night) and some do not care what is in there

we also provide lock boxes if there are safety issues in a home to lock meds up; big draw back: you cannot instruct family before you get there to give some thing from the kit if it is locked;

yes we had homes where meds disappeared, but never any legal implications (one place was so bad! the son insisted he stepped on the IV morphine bag after it slipped out of his hand when he put it in the fridge and it broke open - how could you steal your mothers pain medication??? we did not have pharmacy deliver there any longer, we took it out personally to lock it up)

the content of meds in our emergency bag is not enough to worry about (may be if some one is stupid enough to take the haldol and ativan and morphine all at once)

personally i think we should have a pixis at the office where we can get out what we need for a patient for one or 2 days at a time cause most of the time we destroy all the emergency meds after the patient dies and it is a huge waste!

oh and we always have patients or family who will open the whole thing and call us and tell us they do not need those medications.... we have them rebag them and store them....

just because some will always abuse the system should we have the patients suffer?

I have a question, that i need answered. My Hospice group snowed my mother the other night and i am now in charge of her medicine. This CarePak, that i received...If I terminate Hospice services, am i still allowed to keep the CArePak for my mother? Another questionis, that if i terminate them, am i allowed to uses the rentalas that they leased out for my mother, i.e ox, bed, etc... until she passes? is this going on my mothers medicare/aid?

thank you so much for the answers.

KAma

I do not know what state you are in and there are differences between states. In our hospice agency the rentals would be picked up by our company or at the very least hospice would not continue paying for the equipment. A call to your Doctor's office would assist you with obtaining a new order and for certain items medicare would pay. As far as the meds the remainder of the comfort pak that you had not opened would be removed by our agency those that had already been opened would remain. Please be patient with your agency "snowing" a patient sometimes happens when first starting meds on a patient especially if they are opiate nieve. Often times it is not only the meds that create this effect but a decline in the patient at the same time. You might want to try and work with your group and let them know your concerns so they may assist you at this difficult time of your life.

My experience with ekits are very much what others have stated. I have also worked with HP an they go over kill on what is needed. Have thrown away so many HBR supps, and haldal its horrible. BUT! The idea of the kit is s necessity

I use to work for an agency that insisted that ekits are not ordered for each patient... guess how many emergency calls came in to triage with no ms roxanol ?? for pain, or all of the sudden sob? It happened alot, and nurses are not god. We have NO idea when they these symptoms may or may not appear, but if they do, and there is no MS in the house.. the issue falls on the case managers shoulders.. like everything else.

Specializes in LTC, Hospice.
My experience with ekits are very much what others have stated. I have also worked with HP an they go over kill on what is needed. Have thrown away so many HBR supps, and haldal its horrible. BUT! The idea of the kit is s necessity

I use to work for an agency that insisted that ekits are not ordered for each patient... guess how many emergency calls came in to triage with no ms roxanol ?? for pain, or all of the sudden sob? It happened alot, and nurses are not god. We have NO idea when they these symptoms may or may not appear, but if they do, and there is no MS in the house.. the issue falls on the case managers shoulders.. like everything else.

Perhaps in your job that is the case as well it should be since the case manager is SUPPOSED to be ultimately responsible for the management of the patient care. Unfortunately in my job as well as others in Oklahoma the primary nurse for the patient has become the case manager and the RN simply holds a title.

Specializes in PICU, NICU, L&D, Public Health, Hospice.
My experience with ekits are very much what others have stated. I have also worked with HP an they go over kill on what is needed. Have thrown away so many HBR supps, and haldal its horrible. BUT! The idea of the kit is s necessity

I use to work for an agency that insisted that ekits are not ordered for each patient... guess how many emergency calls came in to triage with no ms roxanol ?? for pain, or all of the sudden sob? It happened alot, and nurses are not god. We have NO idea when they these symptoms may or may not appear, but if they do, and there is no MS in the house.. the issue falls on the case managers shoulders.. like everything else.

Your agency gets to decide which comfort packs they want delivered/used. Our packs never have any HBR supps, some don't have morphine, some have levsin rather than atropine...

To pjtk,

As a home hospice nurse I review all comfort pak contents with my families b/c the families are usually the first to give the medications in the middle of the night or on weekends while they await for the weekend nurse to arrive. I have found it to be a good practice since there are multiple medications and when there is an "emergency" for the families they should be educated and feel comfortable about the contents of the kit. If they are left uneducated they are more likely to make a mistake if the hospice nurse is trying to instruct them over the phone. This generally takes an additional 20-30 minutes to review during a visit, but it sure does help. I would call the hospice you are with and speak with the manager. If how your nurse treated you is the company policy regarding the kits I would interview other hospices. If not, I would request a different nurse. Education is the major part of our job and at the very least she/he should have spoke to you in greater detail regarding the kit.

Gail

Even with good family education, in the middle of the night, with their loved one in pain or other distress, family members tend to forget what they've been taught.

I used to do overnight call, and I always made sure the family was familiar with the CK, and how/when to use it. Many times, they would start to recall what the CM had taught with just a little prompting.

Too bad it's impractical to conduct periodic drills with families, to make the timely and correct use of the CK automatic.

I have a question, that i need answered. My Hospice group snowed my mother the other night and i am now in charge of her medicine. This CarePak, that i received...If I terminate Hospice services, am i still allowed to keep the CArePak for my mother? Another questionis, that if i terminate them, am i allowed to uses the rentalas that they leased out for my mother, i.e ox, bed, etc... until she passes? is this going on my mothers medicare/aid?

thank you so much for the answers.

KAma

Just a quick comment on yor mother being "snowed." Something to take into consideration. Hospice patients are critically ill, and energy is at a premium. If someone is in pain, having shortness of air, anxiety, etc for any length of time, he/she is going to use a lot of energy because of the stress those symptoms place on an already sick person.

Nutrition is often inadequate at the end of life, so spent energy takes longer to replenish. I've seen many times where patients have had a busy day with visitors, etc, need very little medication, and sleep for much longer than usual and are harder to arouse for the next 12-24 hours. In these cases, the "snowing" is less due to meds than recovery. Even pleasurable things take energy.

Not to say that patients don't get snowed sometimes, but just be careful not to mismatch cause and effect, as that can lead to loved ones suffering unnecessarily.

when my mil was on hospice, her comfort kit had a healthy variety of meds.

but the times i wasn't at the house, no one else knew what ea med was used for.

i wrote out their uses, next to ea med.

morphine- pain

ativan- anxiety/agitation

haldol- confusion but also nausea and agitation.

they would then pick the med that best suited her symptoms.

i do wish all e-kits had this.

leslie

Ours had color coded labels--yellow Haldol, green Ativan, etc--and matching colored instructions, but sometimes people still didn't get it. :rolleyes: Some from the stress of the moment, some from inadequate teaching (especially where several people are providing care), and some just from being too far down the left slope of the IQ bell curve.

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