Just wondering...have worked in hospice for 2 years now. I know there is no such thing as an "average" visit time for our patients. But, for the routine full assessments, without problems, how much time do you chart? After playing around with numbers, I figure it takes me about 1 1/2 hrs per patient. That's from start to end, including a phone call or two, conferring with the facility staff, profiling meds, and computer charting. I'm curious to see what other nurses are doing.
Also, I was taught some basic hospice meds guidelines for end of life care at the first hospice I worked at. I know there are many, many different factors to consider, and having a "formula" isn't realistic, but just as a "rule of thumb" they are:
Roxanol 20 mg/1ml 2.5 mg q4h ATC
Roxanol 5 mg q2h PRN moderate BTP pain
Roxanol 5 mg - 10 mg SL q2h PRN severe BTP pain
lorazepam 0.5 mg q2h PRN restlessness/agitation
Tylenol supp 650 mg q4h PRN fever
Scop patch 1 q72h PRN secretions, can go up to 2 or even 3 if need be
I ask because I'm working at a new hospice, and the MD I work with is very, very conservative. (I'm being nice
) Starts patients out c Roxanol 5 mg q6-8 hrs PRN (doesn't make sense to me - peak is 4 hrs..) and lorazepam 0.5 to 1 mg q6h. Doesn't believe in using Scop patches - say it overmedicates the pt. (In that small of a dose??? Not according to HP...) Likes Levsin. I do to but I like to use Scop patches at the first sign of secretions. I should say I work in ALF's, where, basically, Med Techs can't assess pain, so don't use PRN's. Does the above sound realistic? Or was I just taught pain medication at a hospice that is a bit more aggresive? I also find that I have to really "fight" to get even minimal pain relief for most of my patient. It's not pleasant to argue with an MD who is supposed to be a hospice doc. - I always have to psych myself up to do battle. :angryfire But I will continue to do so, because we are the patient's advocate. (Sometimes, the only one)
I was also taught in using methadone. I see so many cases where a pt could benefit, but overall this hospice won't consider using it.
I guess I'm just frustrated..I have the knowledge to give comfort to our patients but I'm not allowed to use it.
Bottom line, is it me, or is it this hospice?
Thanks in advance - this is really bugging me