SNF asking hospice to change meds

  1. Does anyone else have any experience with skilled nursing facilities asking hospices to lower patient's Ativan doses so that the patient meets Obra 22 guidelines?

    I have a patient that takes Ativan 1 mg every 8 hours prn. She has COPD and needs it. She's been at this dose for years. They want me to change it to every 12 hours so it fits in with Obra 22. Does that even apply to a hospice patient not taking the med for behavioral reasons?

    Hope to hear from someone on this real soon. Thanks
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    About silverwillow

    Joined: Mar '06; Posts: 23

    15 Comments

  3. by   doodlemom
    Have you tried to talk with someone in the administration at the SNF? There has to be a way around this. We have hospice patients that we give a heck of a lot more ativan than that and have never been hassled by the facilities.
  4. by   txspadequeenRN
    Im not sure what Obra 22 is and I have worked in LTC all my nursing career. However, alot of this has been hospice and i can tell you that ativan 1 mg every 8 hrs aint nothing.Heck, Ive given Ativan every 15 min . There has to be a way around this. The patient should come first before any regulations and I would think the doc could help to override this crazy red-tape...




    Quote from silverwillow
    Does anyone else have any experience with skilled nursing facilities asking hospices to lower patient's Ativan doses so that the patient meets Obra 22 guidelines?

    I have a patient that takes Ativan 1 mg every 8 hours prn. She has COPD and needs it. She's been at this dose for years. They want me to change it to every 12 hours so it fits in with Obra 22. Does that even apply to a hospice patient not taking the med for behavioral reasons?

    Hope to hear from someone on this real soon. Thanks
  5. by   doodlemom
    I think Obra 22 has to do with chemical restraints but I'm not sure.
  6. by   silverwillow
    Exactly, and in my patient's case, the Ativan is not for chemical restraint. It's unfortunate that hospice patients in SNF are subject to the red tape of it all. For patients at home, we make Ativan, Roxinal, etc available for when they get imminent and really need symptom control. Patients in facilities should have no less.


    Quote from doodlemom
    I think Obra 22 has to do with chemical restraints but I'm not sure.
  7. by   EmptytheBoat
    Quote from silverwillow
    Does anyone else have any experience with skilled nursing facilities asking hospices to lower patient's Ativan doses so that the patient meets Obra 22 guidelines?

    I have a patient that takes Ativan 1 mg every 8 hours prn. She has COPD and needs it. She's been at this dose for years. They want me to change it to every 12 hours so it fits in with Obra 22. Does that even apply to a hospice patient not taking the med for behavioral reasons?

    Hope to hear from someone on this real soon. Thanks
    I have SNF fighting me every step of the way, whether be Obra 22, or
    just indifference. My philosophy, my orders, remain whatever it takes to make the pt. comfortable, I'll settle for no less. God speed!
  8. by   Wildbriar
    I've run into this with various SNF controlled-substance committees, wanting to lower, or even eliminate someone's antipsychotics or antianxiety meds just to meet guidelines. Usually if I talk with the administration of the SNF they are agreeable to leaving things as-is if the primary physician will write a note and corresponding order that reflects the potential harm to the client if meds were reduced. Basically, just a statement from MD that says the person needs it at current dose and why.
  9. by   schroeders_piano
    I think the problem is actually it being prn. If the ativan is ordered prn then it will have to be considered a chemical restraint. If they would write the order ativan 1mg every 8 hours, hold if sedated then it is no longer considered a chemical restraint.
  10. by   ReluctantMonk
    We have Hospice patients in SNF facilities and have never been asked to change any meds ( we have been asked to offer suggestions). If they want a med change or if we recommend a change it is up to them to contact the patient's MD.
  11. by   doodlemom
    Quote from ReluctantMonk
    We have Hospice patients in SNF facilities and have never been asked to change any meds ( we have been asked to offer suggestions). If they want a med change or if we recommend a change it is up to them to contact the patient's MD.
    That's interesting. On any orders, we make sure to call the MD and obtain any orders and then write them in the chart. If they have had to call the doctor for orders, then I feel like I am falling down in my job. If they have to call the MD themselves, what benefit is it to them for them to have your hospice in their building? If I were a DON at a nursing facility, I would be less likely to have hospice in the building if it just made an extra step for my staff. Just my 2 cents.
  12. by   nurselearner
    Do you ever have a problem with the staff bypassing hospice - not calling hospice first so we can evaluate? If so how do you handle that -
  13. by   aimeee
    We get the orders and then write them in the chart as well. In some places they want us to write them into the MAR too.

    We DO have a problem with facilities getting orders without notifying us sometimes. It is just hard for them to remember to do it differently than they are used to. Sometimes the MD's come by and write them themselves without thinking about it being a hospice patient. We just keep educating and educating and educating and trying to be vigilant.
  14. by   ReluctantMonk
    What I wrote is our company's policy. Since we are not an employee of the SNF we cannot take orders from an MD for the patient, we can only ask the facility to call the MD with our recommendations. I know of hospices in this area that contract the MD directly, and I was only describing our policy

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