in home emergency packs

[Al Stephens]

I have a simple question for all the experienced Hospice Nurse out here. does your hospice order some sort of emergency pack for the patients home (I would like to know what is in it, but that is up to your Hospice policy or not), also, for those other on-call Hospice nurses, do you carry an EM Pack, or anything with you? My question is being brought up by my Hospice switching to another pharmacy in town for the on call staff, and they will not carry the meds that we can get from our regular pharmacy, but they are too undermanned (with a pending retirement of one pharmacist) to be able to continue being available for us at nights...Any Answers?

[nwamom]

I have not worked hospice, but this actually happened with a person I knew. They sent the kit to the home and then the family took over administering the drugs, thinking they could do all of them. The liquid ones they didn't even measure correctly. Is this typical. I was thinking about doing hospice work but am hesitant.

[leslie :-D]

if you have trouble getting scope patches, levsin gtts also work like a charm.

leslie

[aimeee, BSN, RN]

I have not worked hospice, but this actually happened with a person I knew. They sent the kit to the home and then the family took over administering the drugs, thinking they could do all of them. The liquid ones they didn't even measure correctly. Is this typical. I was thinking about doing hospice work but am hesitant.

Absolutely not! Families are instructed NOT to open the comfort pak without instruction. They are told to put it in the back of the fridge and just to remember it is there for the day the hospice nurse may tell them its time to get something from it and at that time they will be instructed on what to use and how to use it. Sometimes we have to make other arrangements for the comfort paks because the people in the house are not reliable or there are valid concerns about misappropriation but these are pretty unusual.

I urge you to find out more about hospice work if you are feeling a pull. :)

[Katillac, RN]

A follow up question for those who use EKits in the home, especially those with narcs: I assume that an MD signs an order for these kits. Is it the Primary MD, the Hospice Medical Director, or someone else? Also, I have been told that it's not appropriate for a doc to essentially give a standing order for a narcotic, that writing prophyllactic scripts for narcs for symptoms that may or may not appear isn't legal. Anyone else face this? How do you work with that in regards to EKits?

Thanks,

Katillac

[doodlemom]

I have not worked hospice, but this actually happened with a person I knew. They sent the kit to the home and then the family took over administering the drugs, thinking they could do all of them. The liquid ones they didn't even measure correctly. Is this typical. I was thinking about doing hospice work but am hesitant.

Our kit has single doses of Roxanol and ABH drawn up in syringes, so they shouldn't be able to make that mistake. We also have a note on the package not to open without a nurses instruction.

[doodlemom]

if you have trouble getting scope patches, levsin gtts also work like a charm.

leslie

We've been able to get scope patches again, yay! We use the patches when someone has some time left. For imminent death, we use levsin or atropine gtts.

[doodlemom]

A follow up question for those who use EKits in the home, especially those with narcs: I assume that an MD signs an order for these kits. Is it the Primary MD, the Hospice Medical Director, or someone else? Also, I have been told that it's not appropriate for a doc to essentially give a standing order for a narcotic, that writing prophyllactic scripts for narcs for symptoms that may or may not appear isn't legal. Anyone else face this? How do you work with that in regards to EKits?

Thanks,

Katillac

The doc has to sign a prescription for us to have an E-Kit in the home because it does have Roxanol in it. Most of the time it is the primary physician. It would be illegal for the pharmacy to dispense this without an Rx. We also have Roxanol on our standing orders, but in order to initiate it, we have to contact the doc and get an Rx for it. We have vicodin on our standing orders so if we need something right away, we can get that pretty quick.

[nwamom]

So do different hospices in different states have different regulations? I am not familar with hospice at this time and have not worked it.

[doodlemom]

So do different hospices in different states have different regulations? I am not familar with hospice at this time and have not worked it.

All states require an Rx for Roxanol and other scheduled narcotics - some states have triplicate Rx's that doctor's must use for the scheduled narcotics. Some states require that the original Rx be mailed to the pharmacy after it has been faxed and some states do not. The lawas where I am now are much more stringent than in the previous state.

[nwamom]

So, what I witnessed, which was family members administering drugs and laughing because they did not have their glasses on to measure it goes against the ethics of hospice. I was not able to dissuade at all since the situation was very difficult and all I could do was pray.