Ok, i've only been back in hospice for 3 months, but I have questions...
10 yrs ago, when I did hospice, our agency had a portable suction setup so should a patient be unable to handle secretions, we could suction their oral airway...So, last night when the assisted living facility for my end stage alzheimers patient called and said "she has brown secretions dripping from the side of her mouth," I called my DME provider, went out with a bulb suction, cleaned her mouth with bulb suction...waited for suction, got machine, used yankers...situation resolved....Called MD this morning, got an order for scopolamine patch.....
Called my administrator to let her know about the fiasco with the suction setup delivery (long story, and not important at this point...it got done); she said I should have only done bulb suction (patient still with audible expiratory rhonci), with yankers, airway was cleared..... And when I talked about the scopolamine patch, she said "if it's not a problem to get it today, that is fine, but i would wait until the comfort pack gets there on monday." *****frankly, i'm trying to offset another middle of the night call********
She said suctioning is for people that are actively bleeding from the oral cavity, not for secretions... It's not like I tried to intubate the patient, just wanted to clear her mouth. I don't want to do the wrong thing, and I was called by the assisted living facility to clear her oral cavity. I don't want to irritate my manager, but I want to do the right thing for my patient...***her RR was 24-26, and was 16-18 after yankers.****
Maybe i'm just having trouble adjusting to hospice from the critical care nursing setting. I mean, the assisted living place can't even give medication rectally, let alone use bulb suction (so they will be calling me out for that)...
What do you all think? As for the scopolamine patch, I was following the logorhythm from the hospice pharmacia book that we use.
Any input is greatly appreciated. I mean, isnt' it about treating the symptoms, airway clogged with secretions = clear airway.....
Any input is greatly appreciated. I just don't want to have to field calls all through the night when an assisted living facility is telling me a patient is in distress, and I don't want my company to be charged for an ambulance being called just to clear her oral cavity.
thanks!!!!