Hospice patient receiving TPN ?

doodlemom · Dec 17, 2005

This lady is receiving a lot of TPN and is a no-code. At my hospice, all patients have to be no-codes. Yes we have had patients receiving tube feedings too.

It is against medicare regs to require your patients to be DNR. If this is truly how your hospice runs, then you could lose your funding from medicare.

doodlemom · Dec 17, 2005

I'm confused. Why would a dying person be receiving a great big bag of TPN every night? Isn't that against the hospice philosophy? Thanks:)

We've had very few patients on TPN and it is always with the intent on readying the patient or the family to d/c the treatment. We've mostly had babies, children and young parents - an example is a woman last year who wanted to try to make it until her baby's 1st birthday.

CHPN1680 · Dec 17, 2005

We take many patients with TPN as many hospices will not. Every situation is different. Most often, these patients are coming from an acute care setting where the focus has been on curative measures. Most often, doctors and other health care professionals have not discussed the discontinuation of TPN with their patients in these settings.

When the patient comes to us with TPN, the patient and the family are assessed in terms of where they are in the disease process. The very thought of discontinuing a feeding (even in the form of TPN) often does not seem right, especially to family members. Just as we must discuss the importance of honoring the patients desire not to eat at the end of life, we must discuss the effect of administering TPN to a body that is dying. It is our job to help them understand the benefits and risks of being on TPN based on their current physical condition.

Each family must reach the decsion to discontinue TPN in their own way. As long as with the TPN, the prognosis is less than 6 months, they are eligible for hospice even with TPN.

Blackcat99 · Dec 17, 2005

It is against medicare regs to require your patients to be DNR. If this is truly how your hospice runs, then you could lose your funding from medicare.

Yikes!!!:uhoh21: That's a shocker!!! My boss is the one who told me that all of our patients must be DNR. I sure hope medicare doesn't find out about it.:uhoh21:

doodlemom · Dec 17, 2005

Yikes!!!:uhoh21: That's a shocker!!! My boss is the one who told me that all of our patients must be DNR. I sure hope medicare doesn't find out about it.:uhoh21:

You should tell your boss to check Medicare regs. BTW, this was a question on the test for CHPN and was in the study guide that I studied from.

ray2512 · Dec 18, 2005

The "Hospice Philosophy" is not all the black and white. Nurses should always advocate for the client in what their choices are. They should also advocate for the client by fully informing them of these modalities and the possible advantages and disadvantages. Most people don't have a clue about resuscitation and what it entails.

rosemadder · Jan 18, 2006

I'm confused. Why would a dying person be receiving a great big bag of TPN every night? Isn't that against the hospice philosophy? Thanks:)

A major reason a dying person would be receiving TPN is because the family desires it. Sometimes it takes time for families to let go and accept that a person's illness is terminal. In Hospice, the family is cared for as well as the patient. What is good or right for the patient is not always what is good or right for the family.

RnRatchet · Jan 18, 2006

in hospice, the family is cared for as well as the patient. what is good or right for the patient is not always what is good or right for the family.

yeah! amen to that! that's why we always say patients and families first. sometimes what we know would be best clinically for a family and patient isn't what they are ready for emotionally. often times a little kindness, understanding, and education can go a long way. :)

only1lisa · Jan 19, 2006

I thought when a patient went under hospice care that it superceded any code status they might have had?

RnRatchet · Jan 19, 2006

regarding hospice and dnr.. if the hospice accepts medicare....

eligibility-medicare hospice benefit

1. the patient must be entitled to medicare part a (hospital payments); once the patient decides to enter hospice care, they sign off part a and sign on (elect) the mhb. note: this process is reversible-patients may at a future time elect to return to medicare part a.

2. the patient must be certified by the hospice medical director and 1 physician to have a life expectancy

3. under medicare, dnr status cannot be used as a requirement for admission.

info from..

medicare hospice benefit part 1. turner, r. january 2003. end-of-life physician education resource center http://www.eperc.mcw.edu

DutchgirlRN, ASN, RN · Jan 20, 2006

I had a HH patient just two weeks ago start on TPN and the next day she passed. I couldn't figure what the H*** the doctor was thinking.

I got a new admit today who has terminal CA he is a "DNR with limits". I'm not sure what that means. I'm assuming it means no ventilator but tomorrow I have to get this clarified by the POA. I thought with limits was more of a advanced directives issue?