Hospice failure

Specialties Hospice

Published

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?

Specializes in hospice.

I may only be a hospice CNA, but it looks to me like that doctor has a SEVERE ego problem and hospice may not be an appropriate field for him to be working in. His superiors should discipline him for even considering causing a patient pain and suffering because he felt like his turf got stepped on, and should put him on notice that any repeat of this kind of behavior will lead to him being asked to leave the company.

Seriously though, anyone who thinks that was even close to acceptable behavior toward a patient/family shouldn't even have a job as low-level as mine!

I totally agree. I am sick for the family that they had to agonize over this. One of her daughters who pretty much a child herself called me crying so hard she was hyperventilating saying the nurse was there to rip the PCA out of her dying mother. I'm devastated that I was part of an organization that would do something like this.

Specializes in hospice.

Curious....is it nonprofit or for profit?

Specializes in NICU, PICU, Transport, L&D, Hospice.

Other physicians were attending to her care?

Were they ordering medications that were outside of the hospice POC?

Did the hospice medical director ever have conversation with the other physicians?

Seems like there is an information gap here.

Specializes in L&D, Hospice.

seriously, the med dir should have talked to the case manager as well as at least one of the family doctors

where i worked patients always kept their family physician or other doc as attending, the hospice med dir was only a back up and support; other physicians is no reason to discharge a dying patient! if i was family or a doctor friend of that patient i would report that hospice!

@dusky--for of course

@baloney--she was being given comfort care only; no Rx or treatment of any kind that would disqualify her from hospice. For example, she had severe neck pain possible from a fracture caused by mets. One of the drs ordered a special pillow.....that kind of thing.

Specializes in NICU, PICU, Transport, L&D, Hospice.
@dusky--for of course

@baloney--she was being given comfort care only; no Rx or treatment of any kind that would disqualify her from hospice. For example, she had severe neck pain possible from a fracture caused by mets. One of the drs ordered a special pillow.....that kind of thing.

As mentioned by another participant, the primary physician has every right to remain involved if the patient and family request. Their involvement and promotion of appropriate palliative treatment is not grounds for discharge. Such a request by your medical director then, is unethical and should be reviewed by the ethics committee of the agency. His order to discharge without proper cause could make the agency vulnerable to law suit for abandonment.

Specializes in Psychiatry, Mental Health.

This makes me sick. Sounds like the patient was forgotten in what as a nurse I have always considered the flagship of patient-centered care.

(As a patient with breast CA with mets, it terrifies me.)

I also am confused by the HMD's actions. Many of our patients still see their own AMDs and AMDs send in orders all the time. Our HMDs welcome this. Don't get it. I agree with toomuchbaloney that the ethics committee should look at his actions. If I were the RN CM given that direction, I would refuse.

Specializes in Hospice, Geriatrics, Wounds.
I also am confused by the HMD's actions. Many of our patients still see their own AMDs and AMDs send in orders all the time. Our HMDs welcome this. Don't get it. I agree with toomuchbaloney that the ethics committee should look at his actions. If I were the RN CM given that direction I would refuse.[/quote']

Refuse, AMEN. just because a Dr gives you an order doesn't mean you HAVE to do it. Politely refuse, let your superiors know. I, too, wouldn't be a part of this nonsense.

Sounds like this hospice company may have just made quite the reputation for themselves. I'd run away as fast as possible. Pt comfort is the goal of care, not stroking the doctors egos (though I will say there seems to be some major miscommunication between the case manager and IDT). Was the case manager entering the orders given by other doctors into the poc?

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Who ordered the pump?

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